Abstract
Hybrid closed-loop therapy is an emerging technology transforming the management of type 1 diabetes (T1D). Research studies demonstrate glycemic and quality of life benefits of hybrid closed-loop therapy for people with T1D. Translating these outcomes into standard clinical practice is critical for reimbursement and improving access to this technology.High-quality training is essential for achieving optimal outcomes with hybrid closed-loop therapy. Basic diabetes skills and tasks are as important, or even more important, with closed-loop therapy than with standard insulin therapy and need to be reiterated. Establishing expectations of hybrid closed-loop therapy clearly at the outset promotes long-term usage and optimal outcomes.We share key aspects of training and support for users of commercially available hybrid closed-loop systems and consider who may benefit from this technology.
Highlights
There is compelling evidence that closed-loop systems can improve glycemic outcomes for people with type 1 diabetes (T1D)
In our experience in both the research and clinical setting, high-quality training is essential for optimal outcomes with hybrid closed-loop therapy
Bolus calculators used during closedloop may account only for the insulin on board from a previous bolus, and may not include any closed-loop insulin delivery in the bolus calculation, which can contribute to the risk of hypoglycemia with delayed bolusing
Summary
There is compelling evidence that closed-loop systems can improve glycemic outcomes for people with type 1 diabetes (T1D). Hybrid closed-loop systems are not “plug-in-and-play” and still require user interaction for mealtime bolusing, insulin pump set changes, and continuous glucose monitoring (CGM) device insertion (and sometimes calibrations). There are important differences between closed-loop insulin delivery and standard pump therapy with regard to prandial insulin bolus timing.[1] Closed-loop systems detect the rise in sensor glucose levels if carbohydrate ingestion is not preceded by bolus insulin delivery and automatically deliver increased insulin infusion rates to manage the glucose excursion.
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