The program times are listed in Central European Time (CEST)
Introduction
Broadening usage of closed-loop
Abstract
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Hybrid closed-loop systems are associated with improved glycaemic control and quality of life benefits in children and adults with type 1 diabetes. Commercially available hybrid closed-loop systems are increasingly being used as part of routine clinical diabetes care.
Disparities in clinical outcomes of type 1 diabetes are widening, and inequalities in access to diabetes technologies may perpetuate this. Closed-loop systems may provide an important opportunity to address variations in diabetes outcomes.
In this talk we review the available clinical evidence, and report on our experience of closed-loop use in patient groups where diabetes management can be particularly challenging. We will also discuss key considerations for healthcare providers to promote equitable access to closed-loop technology.
Multi-hormone closed-loop systems
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In this talk, I will summarize results of dual-hormone closed-loop systems, with focus on insulin-and-pramlintide closed-loop systems. The use of insulin-and-pramlintide closed-loop system to improve glucose control as well as alleviate the need for carbohydrate counting will be discussed. Finally, results from the addition of empagliflozin to closed-loop systems will be presented.
Efficacy of Closed-loop Insulin Therapy in Adults Prone to Hypoglycemia – the International Diabetes Closed-Loop Trial Protocol 2
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The objective of DCLP2 trial is to assess the efficacy and safety of home use of a Control-to-Range (CTR) closed-loop (CL) system in patients with type 1 diabetes (T1D) prone to hypoglycemia.
The study design is a Randomized Clinical Trial with 2:1 randomization to intervention with a CL system vs. sensor and pump for 3 months followed by a 3-month extension phase in which the original control group switches to the CL system and the original intervention group continues to use the system. The hybrid CL system includes a Tandem t:slim X2 insulin pump with embedded CTR algorithm and the Dexcom G6 CGM. The control system is patient’s personal insulin pump and Dexcom G6 CGM in an open-loop mode. The primary outcome is baseline-treatment difference in time below 70 mg/dL measured by CGM after 3-month use of CL control versus CGM and pump. Secondary outcomes include no increase of time above target range in CL group vs. control group over 3 months, other metrics of glycemic control, and patient reported outcomes.
From 117 screened adult T1D patients (>1 year), treated by insulin pump > 6 months, with a Clarke score >3 and/or severe hypoglycemia during the previous 6 months and a third party support in case of severe hypoglycemic episode, in two French sites, 72 have been randomized after they showed during a 2-week run-in phase a time spent with Dexcom G6 CGM below 70 mg/dl of 5% or above. Available study data will be presented.
Faster acting insulin analogues in closed-loop insulin delivery
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Diabetes technology options have greatly increased for individuals with type 1 diabetes, with the commercialization of multiple advanced insulin pumps, including hybrid closed-loop devices. Hybrid closed-loop insulin therapy consists of an insulin pump, a connected continuous glucose monitor, and an algorithm that enables automated insulin delivery apart from prandial boluses in response to glucose levels. While improvements seen in glycemic control are reassuring, users of these treatment modalities still experience the everyday burden of feed-forward actions, such as carbohydrate counting or exercise announcement, and still require premeal insulin dosing (bolus) to prevent postprandial glycemic excursion. To fully close the loop, these systems might benefit from a faster insulin action and clearance rate, which are recently reported with novel faster insulin analogues.In this presentation, we will present current data on closed-loop glycemic control with faster insulin formulations in individuals with type 1 diabetes.