Hybrid closed-loop systems in UK type 1 diabetes care: National survey of healthcare professional awareness, confidence, and training needs.

Aims: Hybrid closed-loop (HCL) systems significantly improve glycaemia and have become the standard of care for type 1 diabetes (T1D), leading to the recent widescale implementation programme in England and Wales. Limited data exist regarding UK healthcare professionals' (HCPs) confidence and experience with commercially available HCL systems. This survey aimed to evaluate UK HCPs' awareness, confidence, and training needs concerning commercial HCL systems.

Ethnicity and socioeconomic status do not influence glycaemic outcomes of a tubeless hybrid closed-loop system (Omnipod® 5) in adults with type 1 diabetes.

Aims: We aimed to evaluate real-world glycaemic outcomes of a tubeless hybrid closed-loop (HCL) insulin delivery system in type 1 diabetes (T1D), exploring the influence of ethnicity and socioeconomic status from a publicly funded system with universal access.

Materials And Methods: This was a retrospective observational study in adults with T1D initiating HCL (Omnipod® 5) at a large publicly funded multi-site diabetes service. Baseline glycaemic metrics were compared with 12-week post-initiation data.

Potential benefits of hybrid closed-loop systems for managing moderate- to high-risk individuals with type 1 diabetes during Ramadan fasting.

Aim: We evaluated whether using hybrid closed-loop systems (HCL) provides a safer, more effective fasting experience compared with multiple daily injections with continuous glucose monitoring (MDI + CGM) for people with T1D at moderate-to-high risk in a real-world setting.

Materials And Methods: In this multicentre prospective study, 178 adults with T1D [HCL n = 98 (39 males 59 females); MDI + CGM n = 80 (30 males 50 females)] who chose to fast in Ramadan of 2024 were assessed for clinical and glycaemic profiles and risk stratified according to the International Diabetes Federation-Diabetes and Ramadan (IDF-DAR) criteria. The composite endpoint was completing >15 days of fasting and achieving time in range (TIR) ≥70%, with time below range (TBR) <4%.

Hybrid Closed-Loop Therapy in Adults with Type 1 Diabetes in England: Long-Term Outcomes from a Real-World Observational Study.

To evaluate longitudinal real-world outcomes in adults with type 1 diabetes initiating hybrid closed loop (HCL). Adults with type 1 diabetes, managed with an insulin pump and intermittently scanned continuous glucose monitoring with hemoglobin A1c (HbA1c) ≥8.5% (69 mmol/mol), were started on HCL between August and December 2021 as part of the National Health Service England HCL pilot.

Beyond the Trend Arrow: Potential Value of Artificial Intelligence-Supported Glucose Predictions for People with Type 1 Diabetes Using Continuous Glucose Monitoring Systems.

Advances in diabetes technologies such as continuous glucose monitoring (CGM) have provided significant opportunities to improve glycemic and quality-of-life outcomes for people with type 1 diabetes (T1D). The ambulatory glucose profile and the introduction of glucose thresholds helped a lot to identify patterns, which was the first step toward improving hyper-and hypoglycemia management. Despite these innovations, the relentless burden of day-to-day T1D management continues to be a challenge for individuals and their families.

Patient Experiences and Treatment Satisfaction with Mini-Dose Glucagon as a Treatment for Hypoglycemia Following Repeated, Prolonged Fasts in Type 1 Diabetes During Ramadan.

Mini-dose glucagon (MDG) is a safe and effective option for managing hypoglycemia during prolonged, repetitive fasts in people with type 1 diabetes (pwT1D) during Ramadan. We aimed in this study to evaluate the effectiveness and patient satisfaction of MDG for the management of fasting-induced hypoglycemia from the perspective of pwT1D fasting during Ramadan. We conducted an online survey shared via social media platforms and email announcements from May 2021 to April 2023 to collect feedback from 136 (72 female) persons with T1D about their experiences using MDG.

The use of continuous glucose monitoring in people living with obesity, intermediate hyperglycemia or type 2 diabetes.

A global trend towards increased obesity, intermediate hyperglycemia (previously termed prediabetes) and type 2 diabetes, has prompted a range of international initiatives to proactively raise awareness and provide action-driven recommendations to prevent and manage these linked disease states. One approach, that has shown success in managing people already diagnosed with type 2 diabetes mellitus, is to use continuous glucose monitoring (CGM) devices to help them manage their chronic condition through understanding and treating their daily glucose fluctuations, in assocation with glucose-lowering medications, including insulin. However, much of the burden of type 2 diabetes mellitus is founded in the delayed detection both of type 2 diabetes mellitus itself, and the intermediate hyperglycemia that precedes it.

Long-Term Improvements in Glycemia and User-Reported Outcomes Associated with Open-Source Automated Insulin Delivery Systems in Adults with Type 1 Diabetes in the United Kingdom: A Real-World Observational Study.

To evaluate real-world outcomes in adults with type 1 diabetes initiating open-source automated insulin delivery systems (OS-AID). Adults with type 1 diabetes who commenced OS-AID, between May 2016 and April 2021, across 12 centers in the United Kingdom were included. Anonymized clinical data, collected during routine clinical care between December 2019 and November 2023, were submitted to a secure web-based tool within the National Health Service network.

Automating insulin delivery through pump and continuous glucose monitoring connectivity: Maximizing opportunities to improve outcomes.

The development of automated insulin delivery (AID) systems, which connect continuous glucose monitoring (CGM) systems with algorithmic insulin delivery from an insulin pump (continuous subcutaneous insulin infusion, [CSII]), has led to improved glycaemia and quality of life benefits in those with insulin-treated diabetes. This review summarizes the benefits gained by the connectivity between insulin pumps and CGM devices. It details the technical requirements and advances that have enabled this, and highlights the clinical and user benefits of such systems.

Case series of using automated insulin delivery to improve glycaemic control in people with type 1 diabetes and end stage kidney disease on haemodialysis.

Automated insulin delivery (AID) in people with type 1 diabetes (pwT1D) and end-stage kidney disease (ESKD) on haemodialysis (HD) has not been reported previously. We describe practical considerations and our findings in four pwT1D on HD for ESKD where AID was safely implemented, with significant improvements in time in range.

MiniMed 780G System Use in Type 1 Diabetes During Ramadan Intermittent Fasting: A Systematic Literature Review and Expert Recommendations.

This article offers a systematic literature review (SLR) on the use of the MiniMed 780G automated insulin delivery system (MM780G) in people with type 1 diabetes (PwT1D) during Ramadan intermittent fasting. It also presents consensus recommendations on the use of MM780G during the Ramadan period. The SLR was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology.

Real-world outcomes of Omnipod DASH system use in people with type 1 diabetes: Evidence from the Association of British Clinical Diabetologists (ABCD) study.

Aims: To evaluate real-world outcomes in people with Type 1 Diabetes (PwT1D) initiated on Omnipod DASH® Insulin Management System.

Methods: Anonymized clinical data were submitted to a secure web-based tool within the National Health Service network. Hemoglobin A1c (HbA1c), sensor-derived glucometrics, total daily dose of insulin (TDD), and patient-reported outcome changes between baseline and follow-up were assessed.

Following in Banting's footsteps or straying from the path? Observations from contemporary diabetes innovation.

While advancements in the treatment of diabetes continue to rapidly evolve, many of the newer technologies have financial barriers to care, opposing the egalitarian ethos of Banting who sold his patent on insulin for a nominal cost to allow it to be made widely available. Inequity in access to new therapies drives disparity in diabetes burden with potential for these gaps to widen in the future. The 2023 International Conference on Advanced Technologies and Treatments of Diabetes (ATTD) presented ground-breaking and current research in diabetes technology.

Mesenchymal stromal cell secretory molecules improve the functional survival of human islets.

Aims: Human islet transplantation as a therapy for type 1 diabetes is compromised by the loss of functional beta cells in the immediate post-transplantation period. Mesenchymal stromal cells (MSCs) and MSC-derived secretory peptides improve the outcomes of islet transplantation in rodent models of diabetes. Here, we utilized a mouse model for human islet transplantation and assessed the effects of a cocktail of MSC-secreted peptides (screened by MSC-secretome for human islet GPCRs) on the functional survival of human islets.

Presentation of new onset type 1 diabetes with diabetic ketoacidosis and hyperosmolar hyperglycaemia after a single dose of nivolumab and ipilimumab.

Summary: A Caucasian man in his 60s with recent diagnosis of metastatic renal cell carcinoma presented to the emergency department with a 5-day history of severe polyuria, polydipsia and fatigue and 1-day history of confusion, abdominal pain, nausea and vomiting. Investigations revealed an overlap of diabetic ketoacidosis (DKA) and hyperosmolar hyperglycaemic state (HHS). He had received the first dose of immunotherapy with nivolumab and ipilimumab 3 weeks prior to this attendance.

Hybrid Closed-Loop Therapy in Adults With Type 1 Diabetes and Above-Target HbA1c: A Real-world Observational Study.

Objective: We explored longitudinal changes associated with switching to hybrid closed-loop (HCL) insulin delivery systems in adults with type 1 diabetes and elevated HbA1c levels despite the use of intermittently scanned continuous glucose monitoring (isCGM) and insulin pump therapy.

Research Design And Methods: We undertook a pragmatic, preplanned observational study of participants included in the National Health Service England closed-loop pilot. Adults using isCGM and insulin pump across 31 diabetes centers in England with an HbA1c ≥8.

The First Regulatory Clearance of an Open-Source Automated Insulin Delivery Algorithm.

Open-source Automated Insulin Dosing (OS-AID) algorithms are made publicly accessible so that every facet of their operation can be understood. Currently, commercial AID algorithms are kept proprietary trade secrets, despite the role they take in making life and death decisions for people living with type 1 diabetes. Loop was the second OS-AID algorithm, developed initially by Nate Racklyeft and Pete Schwamb.

A Systematic Review of Commercial Hybrid Closed-Loop Automated Insulin Delivery Systems.

Introduction: Several different forms of automated insulin delivery systems (AID systems) have recently been developed and are now licensed for type 1 diabetes (T1D). We undertook a systematic review of reported trials and real-world studies for commercial hybrid closed-loop (HCL) systems.

Methods: Pivotal, phase III and real-world studies using commercial HCL systems that are currently approved for use in type 1 diabetes were reviewed with a devised protocol using the Medline database.

UK's Association of British Clinical Diabetologist's Diabetes Technology Network (ABCD-DTN): Best practice guide for hybrid closed-loop therapy.

This best practice guide is written with the aim of providing an overview of current hybrid closed-loop (HCL) systems in use within the United Kingdom's (UK) National Health Service (NHS) and to provide education and advice for their management on both an individual and clinical service level. The environment of diabetes technology, and particularly HCL systems, is rapidly evolving. The past decade has seen unprecedented advances in the development of HCL systems.

Management of adults with diabetes on dialysis: Summary of recommendations of the Joint British Diabetes Societies guidelines 2022.

Diabetes is the commonest cause of end-stage kidney disease in many parts of the world, and many people on dialysis programmes live with diabetes. Such people are vulnerable to complications from their diabetes, and their care may be fragmented due to the many specialists involved. This updated guidance from the Joint British Diabetes Societies aims to review and update the 2016 guidance, with particular emphasis on glycaemic monitoring in the light of recent advances in this area.