Practical Considerations and Implementation of Automated Insulin Delivery Systems.

Automated Insulin Delivery (AID) is in a new era of implementation challenges and opportunities for people with diabetes (PWD) and healthcare providers (HCPs). Beyond technologic variation, cost, access, and HCP endorsement/experience lead to uneven uptake of AID technologies, and attenuate universal ease of use. For AID to be broadly implemented, we must prioritize the lived experience for PWD, and consider how to alleviate burden to promote holistic wellbeing.

Early Stages of Automated Insulin Delivery.

The development of automated insulin delivery systems has seen tremendous improvements from individual components to interoperable system combinations of devices and new drugs besides insulin. The components have become progressively smaller, more accurate, and more user friendly. This article summarizes the history of the artificial pancreas from the earliest concepts to fully functional systems to research into further improvements in the future.

Early Stages of Automated Insulin Delivery.

The development of automated insulin delivery systems has seen tremendous improvements from individual components to interoperable system combinations of devices and new drugs besides insulin. The components have become progressively smaller, more accurate, and more user friendly. This article summarizes the history of the artificial pancreas from the earliest concepts to fully functional systems to research into further improvements in the future.

Practical Considerations and Implementation of Automated Insulin Delivery Systems.

The technological progress to date with automated insulin delivery (AID) has ushered in a new era of challenges and opportunities for people with diabetes (PWD), spotlighting implementation considerations. Beyond physiologic and technologic variation, cost, access, and health care professional (HCP) endorsement/experience lead to uneven uptake of AID technologies and attenuate universal ease of use. For AID to be broadly implemented, we must prioritize the lived experience for PWD and consider how to alleviate burden to promote physical/functional health, psychological well-being, and social well-being.

Differences in White Matter Microstructure in Children With Type 1 Diabetes Persist During Longitudinal Follow-up: Relation to Dysglycemia.

Unlabelled: Type 1 diabetes has detrimental effects in white matter microstructure. In a longitudinal study, we investigated whether these reported findings change as children grow and enter puberty. At study entry, there were 143 children with type 1 diabetes and 71 control participants without diabetes, 4-9 years old.

"Can I afford to live today?" The emotional toll of navigating the healthcare system with type 1 diabetes.

Objectives: People with diabetes (PWD) face significant barriers to accessing insulin and diabetes supplies, including high prices, leading some to turn to social media for material support. This study explores emotions among PWD who have relied on assistance from social media networks when navigating access to diabetes medications and supplies (DMS).

Methods: We conducted a mixed methods study of individuals with type 1 diabetes (T1D) and their caregivers who have used social media to obtain DMS.

An Infant With Variant: A Novel Etiology of 46,XY DSD and Literature Review.

46,XY sex reversal 11 (SRXY11) is a rare and recently identified form of 46,XY difference in sexual development (DSD), caused by variants in the DEAH-Box Helicase 37 gene (). is crucial for ribosome biogenesis, but its specific role in gonadal development remains unclear. The genital phenotype varies widely, ranging from typical female to typical male.

Facilitating the Virtual Exercise Games for Youth with Type 1 Diabetes (ExerT1D) Peer Intervention: Protocol Development and Feasibility.

Aims: Adolescents with type 1 diabetes (T1D) face several unique challenges to engaging in moderate-to-vigorous physical activity (MVPA), including uncertainty with diabetes self-management, risk of hypoglycemia, limited access to safe or supportive environments, and diabetes-specific stigma. Opportunities for T1D peer activities with T1D role model support are limited. To address this need, we tested iterative refinements of pilot Virtual Exercise Games for Youth with T1D (ExerT1D) for feasibility and acceptability.

Cost-Effectiveness of Closed-Loop Automated Insulin Delivery Using the Cambridge Hybrid Algorithm in Children and Adolescents With Type 1 Diabetes: Results from a Multicenter 6-Month Randomized Trial.

Background/objective: The main objective of this study is to evaluate the incremental cost-effectiveness (ICER) of the Cambridge hybrid closed-loop automated insulin delivery (AID) algorithm versus usual care for children and adolescents with type 1 diabetes (T1D).

Methods: This multicenter, binational, parallel-controlled trial randomized 133 insulin pump using participants aged 6 to 18 years to either AID (n = 65) or usual care (n = 68) for 6 months. Both within-trial and lifetime cost-effectiveness were analyzed.

Severe Hypoglycemia and the Use of Glucagon Rescue Agents: An Observational Survey in Adults With Type 1 Diabetes.

Severe hypoglycemia (SH) is the most frequent and potentially serious complication affecting individuals with type 1 diabetes and can have major clinical and psychosocial consequences. Glucagon is the only approved treatment for SH that can be administered by non-health care professionals (HCPs); however, reports on the experiences and emotions of people with type 1 diabetes associated with SH and glucagon rescue use are limited. This survey study demonstrated that an increasing number of individuals with type 1 diabetes have current and filled prescriptions for glucagon and have been educated about glucagon rescue use by an HCP.

Personalized Digital Health Information to Substantiate Human-Delivered Exercise Support for Adults With Type 1 Diabetes.

Objective: Pilot-test personalized digital health information to substantiate human-delivered exercise support for adults with type 1 diabetes (T1D).

Design: Single-group, 2-week baseline observation, then 10-week intervention with follow-up observation.

Setting: Community-based sample participating remotely with physician oversight.

Continuous glucose monitoring and metrics for clinical trials: an international consensus statement.

Randomised controlled trials and other prospective clinical studies for novel medical interventions in people with diabetes have traditionally reported HbA as the measure of average blood glucose levels for the 3 months preceding the HbA test date. The use of this measure highlights the long-established correlation between HbA and relative risk of diabetes complications; the change in the measure, before and after the therapeutic intervention, is used by regulators for the approval of medications for diabetes. However, with the increasing use of continuous glucose monitoring (CGM) in clinical practice, prospective clinical studies are also increasingly using CGM devices to collect data and evaluate glucose profiles among study participants, complementing HbA findings, and further assess the effects of therapeutic interventions on HbA.

Assessing Incorporation of Type 1 Diabetes Into Identity: Validation of the Accepting Diabetes and Personal Treatment (ADAPT) Survey in Teens and Young Adults.

Objectives: Teens and young adults with type 1 diabetes (T1D) often demonstrate difficulty with diabetes management, as they struggle to navigate the impact of T1D on their identities---their self-concepts, bodies, social networks, life experiences and desired futures. Positively incorporating T1D into identity may benefit biomedical and psychosocial outcomes. We aimed to validate and assess psychometric properties of the Accepting Diabetes and Personal Treatment (ADAPT) survey, a new measure of incorporation of T1D into one's identity.

DKA Prevention and Insulin Pumps: Lessons Learned From a Large Pediatric Pump Practice.

Purpose: This purpose of the study was to describe recent diabetic ketoacidosis (DKA) incidence data in youth with type 1 diabetes using insulin pumps and the impact of continuous glucose monitors (CGMs) on DKA rates.

Methods: DKA data were obtained through a retrospective chart review of insulin pump users (ages <26 years) between December 2019 and June 2021 in an academic pediatric endocrinology practice where 68% of patients were pump users.

Results: Among 591 pump patients, 28 events occurred (3.

Consensus Recommendations for the Use of Automated Insulin Delivery Technologies in Clinical Practice.

The significant and growing global prevalence of diabetes continues to challenge people with diabetes (PwD), healthcare providers, and payers. While maintaining near-normal glucose levels has been shown to prevent or delay the progression of the long-term complications of diabetes, a significant proportion of PwD are not attaining their glycemic goals. During the past 6 years, we have seen tremendous advances in automated insulin delivery (AID) technologies.

A Pilot randomized trial to examine effects of a hybrid closed-loop insulin delivery system on neurodevelopmental and cognitive outcomes in adolescents with type 1 diabetes.

Type 1 diabetes (T1D) is associated with lower scores on tests of cognitive and neuropsychological function and alterations in brain structure and function in children. This proof-of-concept pilot study (ClinicalTrials.gov Identifier NCT03428932) examined whether MRI-derived indices of brain development and function and standardized IQ scores in adolescents with T1D could be improved with better diabetes control using a hybrid closed-loop insulin delivery system.

Feasibility and Preliminary Safety of Smartphone-Based Automated Insulin Delivery in Adolescents and Children With Type 1 Diabetes.

Background: A smartphone-based automated insulin delivery (AID) controller device can facilitate use of interoperable components and acceptance in adolescents and children.

Methods: Pediatric participants (N = 20, 8F) with type 1 diabetes were enrolled in three sequential age-based cohorts: adolescents (12-<18 years, n = 8, 5F), school-age (8-<12 years, n = 7, 2F), and young children (2-<8 years, n = 5, 1F). Participants used the interoperable artificial pancreas system (iAPS) and zone model predictive control (MPC) on an unlocked smartphone for 48 hours, consumed unrestricted meals of their choice, and engaged in various unannounced exercises.

Lived experience of CamAPS FX closed loop system in youth with type 1 diabetes and their parents.

Aim: To examine changes in the lived experience of type 1 diabetes after use of hybrid closed loop (CL), including the CamAPS FX CL system.

Materials And Methods: The primary study was conducted as an open-label, single-period, randomized, parallel design contrasting CL versus insulin pump (with or without continuous glucose monitoring). Participants were asked to complete patient-reported outcomes before starting CL and 3 and 6 months later.

A Comparison of Postprandial Glucose Control in the Medtronic Advanced Hybrid Closed-Loop System Versus 670G.

We recently reported that use of an "advanced" hybrid closed-loop system reduced hyperglycemia without increasing hypoglycemia compared to a first-generation system. The aim of this analysis was to evaluate whether this improved performance was specifically related to better mealtime glycemic control. We conducted a secondary analysis of postprandial glycemic control in an open-label, multinational, randomized crossover trial of 112 participants with type 1 diabetes, aged 14-29, of the Medtronic MiniMed™ 670G hybrid closed-loop system (670G) versus the Medtronic advanced hybrid closed-loop (AHCL) system, for 12 weeks each.