Type 1 diabetes (T1D) is a chronic, life-long condition that requires ongoing management of blood glucose levels. Achieving optimal glycaemic control is essential for reducing the risk of complications associated with diabetes (6). The use of a hybrid closed-loop system is a recent advancement in the management of T1D that has been developed to assist with glycaemic control (5). Precisely, a hybrid closed-loop system is an automated insulin delivery system that uses a continuous glucose monitor (CGM) connected to an insulin pump (6). It utilizes the CGM’s glucose readings to automatically adjust the insulin infusion rate from the pump, allowing for more accurate and personalized insulin delivery (6). The article by Hicks (2) explains why the use of a hybrid closed-loop system is beneficial for managing blood glucose levels in T1D, making it relevant material for the topic. This mini-review will discuss this research in regard to the potential benefits and challenges associated with the use of a hybrid closed-loop system in T1D care.
The article “‘Artificial Pancreas’ Technology to Change Lives in Type 1 Diabetes” provides a brief overview of the mentioned new technology. Hicks (2) claims that a hybrid closed-loop system will specifically aid people with T1D in managing their disease better. By continually monitoring blood glucose levels and modifying the amount of insulin supplied through a pump, this device does away with the necessity for finger prick tests and eliminates life-threatening hypoglycaemic and hyperglycaemic emergencies (2). In addition to helping people with T1D and their carers live better lives, hybrid closed-loop devices are more successful than traditional therapy in maintaining blood glucose levels in a healthy range. Moreover, this benefit is supported by clinical trials and real-world research (2). Finally, the National Institute for Health and Care Excellence (NICE) is presently consulting on the usage of this technology. It is seeking an agreement on a price that is both affordable and attractive so that people who need it can access it.
The evaluation of research within the scope of the use of a hybrid closed-loop system in T1D reveals promising results and potential applications. As such, studies have shown that the use of hybrid closed-loop systems can lead to improved glycemic control and reduced hypoglycemia for people with T1D (1, 3, 4, 5, 6, 7). For example, in the case series study of Daly et al. (1), five of the seven patients had an improvement in percentage time in the target glucose range. However, further prospective studies are needed to confirm these findings. In addition, Viral and Satish (5) came to the conclusion that hybrid closed-loop systems show superior performance to standard treatment in terms of preserving healthy blood glucose levels. Likewise, according to Templer (6), those who are expecting a child or considering becoming pregnant are also candidates for the technology because blood sugar levels are more difficult to control during this time. Thus, the results suggest that hybrid closed-loop systems may represent a practical approach to improving glycemic control for people with T1D.
However, the research suggests several challenges associated with the use of hybrid closed-loop systems to manage blood glucose levels in T1D. These difficulties specifically include tackling inequality concerns connected to parental background and socioeconomic factors as well as developing a uniform reporting method for more straightforward data interpretation (2, 5). As a result, the draft recommendations from NICE also require the National Health Service (NHS) England to decide on a cost-effective expenditure for the systems on behalf of appropriate health bodies (2). In turn, for increased adoption, standardized reporting will require input from providers, patients, diabetes device manufacturers, and regulators (5). Overall, the use of hybrid closed-loop systems to manage blood glucose levels in T1D is complicated by optimizing settings to interpret glucose, insulin, and factors affecting glucose, tackling inequality concerns, and developing a standardized reporting method that requires input from providers, patients, diabetes device manufacturers, and regulators.
The current evidence also suggests that hybrid closed-loop systems are beneficial in the financial aspect. For instance, Hicks (2) claims that this technology is more cost effective than traditional treatment methods for people with T1D. Templer (6), who described the technical evolution of closed-loop systems from bulky and bedside technology to more minor, wearable devices, lends weight to his assertion. As more hybrid closed-loop systems have become commercially accessible, the evidence for such systems’ effectiveness has also increased (6). The author provides sufficient evidence for his argument by describing a systematic review and meta-analysis of randomized controlled trials, which found that the use of hybrid closed-loop systems reduced total healthcare costs compared to conventional insulin delivery systems (6). This effect was primarily due to reduced hospitalizations and medical visits, as well as improved glycemic control. Future challenges include the creation of fully closed-loop systems that do not need user input for meal presentations or carbohydrate measurement (6). Hence, the findings suggest that hybrid closed-loop systems are more cost-effective than conventional care for people with T1D managing their glucose levels, although improvements are possible.
Nevertheless, the current research on the use of a hybrid closed-loop system to manage blood glucose levels in T1D is still in its early stages. Certain insufficiencies plague it regarding data, samples, evidence, and scope. Firstly, the majority of studies conducted so far have focused on the efficacy of the technology and its ability to improve glycemic control. Still, more data is needed to ascertain the system’s long-term safety and effectiveness. Secondly, the available studies have primarily included a limited number of participants, thus reducing the generalizability of the results. Thirdly, further research is necessary to identify which groups of people may most benefit from the use of a hybrid closed-loop system and which may not benefit from the technology at all. Moreover, more research is needed to determine the optimal settings, timing, and duration of use for the system to achieve maximum benefits. Finally, additional studies should be conducted to evaluate the impact of the hybrid closed-loop system on patient quality of life and mental health.
In conclusion, using a hybrid closed-loop system to control the blood sugar levels of people with T1D seems to be a promising strategy for enhancing glycemic control, lowering hypoglycemia episodes, and maybe lowering healthcare expenditures. However, to prove long-term safety and efficacy, determine the ideal locations, timing, and duration of usage, and assess the effects on patient quality of life and mental health, more research is required. In addition, more information is necessary to identify which demographic groups stand to gain the most from this innovation and which might not test and implement the technology.
References
Daly A, Hartnell S, Boughton CK, Evans M. Hybrid Closed-loop to Manage Gastroparesis in People With Type 1 Diabetes: a Case Series. Journal of Diabetes Science and Technology [Internet]. 2021 [cited 2023];15(6):1216–23. Web.
Hicks R. “Artificial Pancreas” Technology to Change Lives in Type 1 Diabetes [Internet]. Medscape UK. 2023 [cited 2023]. Web.
Nallicheri A, Mahoney KM, Gutow HA, et al. Review of Automated Insulin Delivery Systems for Type 1 Diabetes and Associated Time in Range Outcomes. Endocrinology [Internet]. 2022 [cited 2023];18(1):27. Web.
Renard E. Automated insulin delivery systems: from early research to routine care of type 1 diabetes. Acta Diabetol [Internet]. Web.
Viral N. Shah, Satish K. Garg. Standardized Hybrid Closed-Loop System Reporting. Diabetes Technology & Therapeutics [Internet]. 2021 [2023];23(5):323–31. Web.
Templer S. Closed-Loop Insulin Delivery Systems: Past, Present, and Future Directions. Front Endocrinol [Internet]. 2022[cited 2023];13:919942. Web.
Ware J, Hovorka R. Closed-loop insulin delivery: update on the state of the field and emerging technologies. Expert Review of Medical Devices [Internet]. 2022 [cited 2023];19(11):859–75. Web.