Background and Aims / Part 1

Background: Automated insulin delivery (AID) systems have the ability to dramatically improve glycemic control for patients with type 1 diabetes (T1D) while reducing burden and hypoglycemia. Early versions of these systems are hybrid closed loop (HCL) requiring user input of carbohydrate intake and often benefiting from user-initiated corrections and proper tuning. Such systems are thus not plug-and-play but rather complex medical aids for which users benefit from proper training and onboarding to optimize device use and benefit.

Methods / Part 2

Methods: I will review the published literature on HCL device training and clinical adoption of this technology across different clinical centers. I will also present the HCL implementation protocols from our large clinical center as well as those proposed for emerging HCL clinical trials.

Results / Part 3

Results: Multiple reports have demonstrated user attrition of HCL use with early generation devices. Increased burden has been postulated as the primary driver. Clinical trials on newer generation systems have indicated the potential for sustained use with improved device builds. Multiple system designs are emerging, each of which may require different forms of user training and onboarding.

Conclusions / Part 4

Discussion: New AID systems will continue to reduce device burden while improving overall glycemic control. Proper understanding of these devices is essential to drive appropriate patient training and system onboarding.

Background and Aims / Part 1

While the benefits of regular physical activity are well established for individuals with type 1 diabetes, glucose control remains a challenge with conventional therapeutic tools during and after physical activity. Factors affecting glucose fluctuations include activity type (aerobic, anaerobic or mixed), intensity and duration of the activity, level of hydration, the secretion of counter-regulatory hormones as well as the amount of insulin and nutrients in the body when the physical activity is performed.

Closed-loop glycemic control (or artificial pancreas), characterized by glucose-responsive automated insulin delivery is now a routine clinical reality for many individuals living with type 1 diabetes. To date, there are two approved single-hormone closed-loop systems available: Minimed 670G (Medtronic, USA) and more recently Control-IQ (Tandem Diabetes Care, USA), while there are several other devices extensively evaluated at home, mainly unsupervised, and for longer periods. The performance of closed-loop glycemic control in individuals with type 1 diabetes during and after the physical activity has been extensively evaluated, including single and dual hormone glucose control, different clinical settings and exercise modalities, various age groups, and adding additional signals to detect physical activity, such as activity and heart rate monitoring.

In this presentation, we will present current data on closed-loop glycemic control challenged by physical activity.

Background and Aims

Diabetes devices--insulin infusion sets, patch pumps, flash and continuous glucose sensors--all involve adhesive patches adhered to the user’s skin. Wear is often for an extended amount of time (3-14 days), and requires continued, repeated exposure to chemical and mechanical agents. As a result, exposure to adhesives lead to acute and chronic skin problems that may impede comfortable use of diabetes devices. The aim of this presentation is to delineate types of skin complications associated with diabetes devices, and discuss strategies to optimize skin protection, adhesion, removal, and healing.

Methods

Review of current literature was undertaken to determine types of common skin reactions to diabetes devices, and recommendations for treatment and sustained device use

Results

Skin complications from device use can be delineated into two primary categories: Contact irritation and contact allergy. Contact irritation causes direct damage to skin via chemical or mechanical agents, and results in a non-immune inflammatory response. Contact allergy is a hypersensitization of the immune response to a chemical agent in the adhesive. It can be immediate (Type 1 hypersensitivity, IgE mediated) or delayed (Type 4 sensitivity T-cell mediated). Contact allergy has been documented in response to isobornyl acrylate, colophonium, ethyl cyanoacrylate and N,N-dimethylacrylamide. Different devices contain different agents in their adhesives.

Conclusions

To minimize complications from contact dermatitis, clinicians should discuss prophylactic strategies with users, including skin preparation and chemical/physical barriers. Adhesive problems can be addressed with overpatches and tackifiers. Sensor removal agents and techniques are important for healing. For contact allergy, it may be possible to use a skin protecting layer between the native adhesive ad skin, however complete avoidance of the offending agent is often indicated. Overall, device manufacturers should increase transparency about chemical agents found in device adhesives, and careful skin care may reduce incidence of complications.