Insulin Pump Research Articles

Automated Insulin Delivery Systems for treatment of type 1 diabetes: Strategies for Optimal Performance.

The use of automated insulin delivery (AID) devices is now widespread in the management of type 1 diabetes (T1D), being used for younger and older children, adolescents and adults. The integration of insulin pumps with continuous glucose monitors (CGM) and smart management software in AID systems has significantly improved glycemic management compared to the separate application of each diabetes technology. The efficacy of AID systems has been demonstrated in randomized controlled trials (RCTs) but it is their application in real-world studies that fully demonstrates their impact for people with T1D. Available AID systems differ in how they are initiated and how they calculate and deliver insulin, which dictates the parameters that can be adjusted for each system. Here we discuss how each system can be best optimized for each individual user, taking into account their activities of daily life, including mealtimes and physical activity, with a focus on commercially available systems for pediatrics (Medtronic MiniMed 780G, Tandem Control IQ, Omnipod 5, CamDiab CamAPS and BetaBionics iLet. Another FDA-cleared AID is the Tidepool Loop, which, although not yet in real-world on-label use, is currently utilized in its open-source format). We also look at the essential process of initiating AID therapy with these devices and how to navigate the important first steps, once the decision to start using an AID system has been made. AID systems should be considered for all individuals with T1D who wish to use them, with a strong emphasis on ensuring equitable access to this technology. Achieving success with AID requires comprehensive guidance, education, and support with a focus on core diabetes management principles. These systems are relatively easy to initiate, from any prior therapy and at any time, including shortly after diagnosis, using personalized and appropriately proactive settings. Effective meal management remains crucial for achieving optimal glycemic control, while regular follow-up and timely adjustments to AID settings are essential for maintaining their effectiveness over time.

Exploring low-dose glucagon for exercise-induced hypoglycaemia in type 1 diabetes: A randomised controlled trial.

This study was designed to compare the effectiveness of a single subcutaneous (s.c.) glucagon dose versus the same total dose split into a dose before and after and placebo (PBO) in preventing exercise-induced hypoglycaemia in adults with type 1 diabetes (T1D). Twenty-two adults with T1D participated in a randomised, single-blinded, three-arm crossover study. Participants underwent a 60-min bout of moderate-intensity cycle ergometry (~50% HRmax) in fasted state, followed by 2 h of rest. Plasma glucose (PG) concentrations were monitored at 5- and 15-minute intervals. Participants were randomly assigned to receive two separate injections before (t = 0 min) and just after (t = 60 min) exercise: (i) 150 μg s.c. glucagon (G150) before and PBO after; (ii) 75 μg s.c. glucagon (G75*2) before and after; or (iii) PBO before and after. Insulin pump users reduced their basal insulin rate by 50% during cycling. The occurrence of hypoglycaemia did not significantly differ between arms (G150: 7, G75*2: 5 and PBO: 6 events, p = 0.078). Mean PG levels throughout the trial were lower in the PBO arm compared to both glucagon arms (G150: 8.6 ± 2.9, G75*2: 8.9 ± 3.4 and PBO: 7.3 ± 2.6 mmol/L, p = 0.015). Time spent with PG in target range (3.9-10.0 mmol/L) was higher in the PBO arm versus both glucagon arms (G150: 63.9 ± 38.9%, G75*2: 60.0 ± 34.1% and PBO: 82.7 ± 29.6%, p = 0.005), driven by less time above range (G150: 32.9 ± 41.3%, G75*2: 35.9 ± 36.4% and PBO: 13.2 ± 30.2%, p = 0.007). Low-dose native glucagon did not offer any advantages in preventing exercise-induced hypoglycaemia in individuals with T1D, regardless of glucagon dosing variations.

Insulin Delivery Pumps for Human Spaceflight: Steps Toward an Accessible Space Future.

Commercially available insulin pumps for treatment of diabetes mellitus are currently not qualified to operate in the space environment. This work rigorously tested the fluid delivery performance of a Tandem t:slim X2 insulin pump in both micro- and hypergravity during a parabolic microgravity research flight. The parabolic research flight environment serves as an analogue to the types of transient gravitational loadings experienced during human-led missions, which provides a foundation to expand testing to suborbital and orbital flights in addition to other extreme environmental tests for wilderness dependency. The results of the flight data showed no significant difference between fluid delivery performance at 0, 1, and 2g acceleration regimes, nor at the transitions between gravity environments. Recommendations are made for further experimentation and qualification tests before use in future spaceflight missions.

A Comparison of Glucose and Additional Signals for Three Different Exercise Types in Adolescents with Type 1 Diabetes Using a Hybrid Closed-Loop System.

Objective: To compare glycemic outcomes during and following moderate-intensity exercise (MIE), high-intensity interval exercise (HIE), and resistance exercise (RE) in adolescents with type 1 diabetes (T1D) using a hybrid closed-loop (HCL) insulin pump while measuring additional physiological signals associated with activity. Methods: Twenty-eight adolescents (average age 16.3 ± 2.1 years, 50% females, average duration of T1D 9.4 ± 4 years) using HCL (Medtronic MiniMed 670G) undertook 40 min of MIE, HIE, and RE. A temporary glucose target (8.3 mmol/L, 150 mg/dL) was set for 2 h prior and during exercise. Heart rate, accelerometer, venous glucose, lactate, ketones, and counter-regulatory hormones were measured for 280 min postexercise commencement. The primary outcome was glucose percentage time in range (TIR): 3.9-10 mmol/L (70-180 mg/dL) for 14 h from exercise onset. Results: Median (interquartile range) TIR for HIE was 88 (78, 96)%, MIE 79 (63, 88)%, and RE 86 (72, 95)% for 14 h from exercise onset. For MIE compared with HIE, TIR was lower (P = 0.012) and time above range (TAR) was greater (18 [2.4, 28] vs. 6.9 [0.0, 14]%, P = 0.041). Hypoglycemia occurred in 13 (46%), 11 (39%), and 14 (50%) of participants for HIE, MIE, and RE, respectively, the majority following the meal after exercise. There were higher levels of lactate (P = 0.001), growth hormone (P = 0.001), noradrenaline (P = 0.001), and heart rate (P = 0.01) during HIE and RE compared with MIE. Conclusions: HCL use in adolescents with T1D results in excellent TIR during different forms of exercise when a temporary target is set 2 h before. Extending the temporary target after exercise may also be needed to help minimize postexercise hypoglycemia.

Approach to the Patient using Diabetes Technology in Pregnancy.

Diabetes in pregnancy increases risk for complications for the pregnant patient and neonate. Tight glycemic control to maintain glucose levels as close to non-diabetic ranges as possible can lower risk for these complications. Achieving strict glycemic targets can be challenging and technologies including continuous glucose monitors (CGM) and hybrid closed loop (HCL) insulin pumps have the potential to improve diabetes control and pregnancy outcomes. The aim of this review is to present and appraise the current data about use of these technologies in pregnancy. In pregnancies with type 1 diabetes (T1D), CGM can improve glycemic control and reduce risk for neonatal complications. International consensus guidelines recommend >70% time in pregnancy target range (TIR) of 63-140 mg/dL (3.5-7.8 mmol/L) and there is data to suggest higher TIR in pregnancies with T1D can reduce risk for neonatal complications including fetal overgrowth and pregnancy complications like preeclampsia. Recent randomized controlled trials have demonstrated improved glycemic outcomes with use of HCL insulin pumps in pregnancy with T1D, though the results vary depending on the system used and available glycemic targets. In pregnancies with type 2 diabetes (T2D) and GDM, retrospective data suggests CGM can improve glycemia but there is limited data about outcomes or optimal CGM targets. Studies have reported glycemic measures for pregnancies without diabetes which may serve as a guide for further outcomes studies of T2D and GDM. Access to diabetes technology and the necessary healthcare systems to support use of these devices may be barriers that contribute to healthcare disparities.

Experience of using insulin pump therapy in underprivileged children from LMIC countries

Experience of using insulin pump therapy in underprivileged children from LMIC countries

Glycemic and Psychosocial Outcomes of Advanced Hybrid Closed-Loop Therapy in Youth With High HbA1c: A Randomized Clinical Trial.

To determine the efficacy of advanced hybrid closed-loop (AHCL) therapy in a high-risk cohort of youth on continuous subcutaneous insulin infusion (CSII) with or without continuous glucose monitoring (CGM) with suboptimal glycemia. In a 6-month multicenter clinical trial, youth with type 1 diabetes with mean and most recent HbA1c >8.5% (65 mmol/mol) were randomly assigned 1:1 to AHCL or treatment as usual (CSII ± CGM). The primary outcome was the 24-week between-group difference in HbA1c. Secondary outcomes included CGM metrics from masked CGM and psychological measures (youth-reported problem areas in diabetes [PAID], quality of life, anxiety, depression, and hypoglycemia fear) assessed using validated questionnaires. A total of 42 participants were randomized (mean [SD] age 16.2 [2.5] years, HbA1c 9.8 [1.1]% or 84 [12] mmol/mol, PAID score 50.3 [19.8]). At study end, the mean (SD) HbA1c was 8.8 (1.1)% or 73 (12) mmol/mol with AHCL and 9.9 (1.2)% or 85 (13.1) mmol/mol with CSII ± CGM, with mean adjusted group difference of -0.77% (95% CI -1.45 to -0.09) or -8.4 mmol/mol (-15.8 to -1.0); P = 0.027. AHCL increased time in range 70-180 mg/dL (difference 19.1%; 95% CI 11.1 to 27.1), reduced time >180 mg/dL (difference -17.7%; 95% CI -26.6 to -8.8), with no increase in time spent <70 mg/dL (difference -0.8%; 95% CI -2.7 to 0.6). There was no evidence for difference in psychosocial outcomes between the two groups at study end. AHCL should be encouraged in youth with suboptimal glycemia, as AHCL improves glycemia. However, psychological support remains vital, as technology alone may not be able to reduce the burden of diabetes care in this subgroup.

Ethnic disparities in HbA1c and hypoglycemia among youth with type 1 diabetes: beyond access to technology, social deprivation and mean blood glucose

IntroductionThe UK national pediatric diabetes audit reports higher HbA1c for children and young people (CYP) with type 1 diabetes (T1D) of Black ethnicity compared with White counterparts. This is presumably...

Performance of a safety protocol for scuba diving in people with type 1 diabetes: 20years of "Diabete Sommerso®" experience.

Scuba diving for people with diabetes was discouraged due to hypoglycemia risks. However, evolving guidelines now enable safe diving for people with diabetes. Among them, the Diabete Sommerso® safety protocol. This study aims to describe data from 20years of DS activities and evaluate the performance of the protocol in avoiding metabolic complications. During DS camps, participants are trained to monitor glycemia before and immediately after diving, aiming for stable levels between 150-250mg/dl. Since 2004, glycemic data from dives conducted with DS/independently by its members have been collected. DS issued diving licenses to 74 type 1 diabetic people. Data are available for 68: median age was 32years (IQR 22 yrs), diabetes duration 18years (IQR 16 yrs), HbA1c 7% (IQR 1%). 34 used insulin pumps, 43 continuous glucose monitoring. A total of 1179 dives were analyzed, showing a median reduction in glycemia of -38mg/dl during dives (IQR 92mg/dl, p<0.0001). Post-dive hypoglycemia occurred in 23 cases, 45% of which involved protocol non-adherence. Hypoglycemia prevalence was 1.7% when the protocol was followed. No severe hypoglycemic episodes occoured during/after diving. Data from 1179 dives indicate that, with adherence to the safety protocol, scuba diving is safe and poses no risk of severe hypoglycemia for people with type 1 diabetes.

Pilot Study of a Modified DOPS Scale for Insulin Pump and CGM Installation Training in Chinese Medical Students During Endocrinology Rotations.

Direct Observation of Procedural Skills (DOPS) is a clinical assessment tool that enables trainers to observe medical students' procedural abilities in real-time clinical settings. It assesses students' knowledge application, decision-making, and skill proficiency during clinical tasks. This study modifies the DOPS to evaluate the operation of insulin pumps (PUMP) and continuous glucose monitoring systems (CGMS) in diabetes management. Key elements of the modified DOPS include 1) Knowledge Assessment: Evaluating understanding of PUMP and CGMS, including interpreting CGMS data for insulin adjustments; 2) Operational Skills: Assessing correct PUMP needle insertion, programming, and adjustments; 3) Patient Safety: Ensuring safe and aseptic procedures; 4) Feedback: Providing constructive feedback to help students improve their skills. Training through DOPS led to significant improvements in all domains, overall performance scores, and reduced execution time for each domain. Correlations between domains showed that PUMP indication scores were linked to all other domains and execution times, including re-evaluation. Communication skills and seeking assistance were crucial factors influencing other domains. Multilinear regression analysis revealed that while DOPS-CGMS (R square 1.0) fully explained performance scores, DOPS-PUMP (R square 0.984) indicated that additional personal qualities significantly impacted students' PUMP operation performance. This customized DOPS form offers insights into students' abilities in managing diabetes with PUMP and CGMS, while emphasizing the need for training on both technical skills and interpersonal skills in future educational models.

Septic infection at the insulin pump injection site A case report

Skin infections in diabetic patients are a complex pathologic process requiring high attention 1.

Long-Term Benefits of Continuous Glucose Monitoring Combined with Insulin Pump Therapy

Objective: To evaluate the long-term efficacy and safety of continuous glucose monitoring (CGM) combined with insulin pump therapy, focusing on glycemic control, patient adherence, quality of life, and reduction in diabetes-related complications. Methodology: A prospective cohort study was conducted on 100 patients with type 1 or insulin-dependent type 2 diabetes from February 2023 to July 2024 at a Tertiary Care Hospital in Karachi. Participants, aged 18–75 years, used CGM-integrated insulin pump therapy. Key metrics included HbA1c levels, time-in-range (TIR), adherence rates, and quality-of-life scores assessed at baseline and study completion. Statistical analyses were performed using SPSS, with significance set at p &lt; 0.05. Results: The mean HbA1c level decreased to 8.14% (SD: 0.83, p = 0.003), while TIR improved to 67.90% (SD: 12.57, p = 0.001). Adherence rates were high, averaging 89.81% (SD: 5.62, p = 0.02), reflecting strong patient engagement. Quality-of-life scores also increased significantly, with a mean score of 79.74 (SD: 11.28, p = 0.015). No severe adverse events were reported, underscoring the safety of the intervention. Conclusion: CGM combined with insulin pump therapy significantly improves long-term glycemic control, adherence, and quality of life in diabetes management. These findings highlight the clinical and psychosocial benefits of integrating these technologies, particularly in achieving sustainable outcomes. Future research should explore broader population impacts, cost-effectiveness, and advanced technological integration

Investigating Racial Disparities in Insulin Pump Use Among People with Type 1 Diabetes Across the United States: A Retrospective Multicenter Study

Introduction: Despite technological advances in Type 1 Diabetes Mellitus (T1D) management, racial disparities in insulin pump utilization persist. We investigated patterns of insulin pump adoption across different racial groups using a large-scale, multi-institutional database to quantify these disparities and identify potential intervention points. Methods: We conducted a retrospective cohort study using the TriNetX research network, analyzing data from 978,665 T1D patients across 66 healthcare organizations. Propensity score matching was employed to balance cohorts, with a focused sub-analysis of Buffalo, NY (n=6,080) to examine regional variations in comparison to the United States nationwide present data. Results: Nationwide data revealed significant racial disparities in insulin pump utilization, with White patients showing the highest adoption rate (11.74%) compared to Black or African American (AA) patients (4.056%). Buffalo cohort demonstrated higher overall adoption rates but maintained similar disparity patterns (White: 30.18%, Black or AA: 13.75%). Post-matching analysis confirmed these disparities persisted independent of demographic factors. Conclusions: Our findings reveal significant racial disparities in insulin pump adoption, with regional variations suggesting the influence of institutional factors. These results highlight the need for targeted interventions to promote equitable access to diabetes technology and prevent the widening of health disparities in T1D care.

Addressing Disparities Using Continuous Glucose Monitors and Remote Patient Monitoring for Youth With Type 1 Diabetes.

Youth with type 1 diabetes (T1D) and public insurance have lower diabetes technology use. This pilot study assessed the feasibility of a program to support continuous glucose monitor (CGM) use with remote patient monitoring (RPM) to improve glycemia for youth with established T1D and public insurance. From August 2020 to June 2023, we provided CGM with RPM support via patient portal messaging for youth with established T1D on public insurance with challenges obtaining consistent CGM supplies. We prospectively collected hemoglobin A1c (HbA1c), standard CGM metrics, and diabetes technology use over 12 months. The cohort included 91 youths with median age at enrollment 14.7 years, duration of diabetes 4.4 years, 33% non-English speakers, and 44% Hispanic. Continuous glucose monitor data were consistently available (≥70%) in 23% of the participants. For the 64% of participants with paired HbA1c values at enrollment and study end, the median HbA1c decreased from 9.8% to 9.0% (P < .001). Insulin pump users increased from 31 to 48 and automated insulin delivery users increased from 11 to 38. We established a program to support CGM use in youth with T1D and barriers to consistent CGM supplies, offering lessons for other clinics to address disparities with team-based, algorithm-enabled, remote T1D care. This real-world pilot and feasibility study noted challenges with low levels of protocol adherence and obtaining complete data in this cohort. Future iterations of the program should explore RPM communication methods that better align with this population's preferences to increase participant engagement.

Six months of hybrid closed-loop therapy improves diabetes-specific positive well-being, and reduces diabetes distress and fear of hypoglycemia: secondary analysis of a randomized controlled trial

IntroductionThis analysis aimed to investigate diabetes-specific psychological outcomes among adults with type 1 diabetes (T1D) using hybrid closed-loop (HCL) versus standard therapy.Research design and methodsIn this multicenter, open-label, randomized, controlled,...

Characteristics of people with type 1 diabetes influence the educational process for starting insulin pump therapy: an observational study.

Limited data exist on educational programs for people using insulin pump (IP) therapy or those considering its initiation, and the influence of individual characteristics on their educational pathway remains unclear. Our aim was to analyze the characteristics of people with type 1 diabetes (T1D) referred for IP therapy and how these characteristics may influence their educational process. A retrospective descriptive observational study was carried out on people with T1D referred for participation in a structured pre-IP educational program in a hospital setting. Educational, sociodemographic and clinical variables were collected and analyzed. Participants were followed up 5 years after IP placement. Seventy-one people finalized the educational program, of whom 10 experienced major barriers to completing it. People with lower educational level required more sessions and weeks to complete it compared to those with higher educational levels. People referred due to suboptimal metabolic control and hypoglycemia also required more time to complete the process. It is essential for diabetes educators to recognize the diversity of characteristics, needs and challenges among the participants in an educational program. Based on this, they must adapt strategies to provide more effective, person-centered diabetes education and support, fostering positive and sustained outcomes and engagement for participants.

An Overview on Equipment and Preparation for Insulin

For the treatment of diabetes, a chronic illness that impacts millions of people globally, insulin preparations are crucial. The various insulin formulations—rapid-acting, short-acting, intermediate-acting, and long-acting insulins—are described in this abstract. Each is intended to fulfill particular therapeutic requirements depending on the patient's blood glucose levels and lifestyle. The initiative also looks at the many tools used to administer insulin, such as insulin pumps, insulin pens, and conventional syringes. With pre-set doses for convenience, insulin pens offer a more user-friendly alternative to syringes, which can be heavy and difficult to use. Continuous insulin delivery from insulin pumps improves glucose control and increases mobility in day-to-day activities. In order to guarantee the efficacy and safety of insulin and related devices, it is also stressed how crucial it is to handle, store, and dispose of them properly. The ultimate goal of this initiative is to improve patient outcomes and diabetes management by increasing knowledge about insulin formulations and administration instruments. In conclusion, the project offers a thorough rundown of insulin varieties and delivery tools, emphasizing their importance in the efficient management of diabetes

Enhanced Metabolic Control in a Pediatric Population with Type 1 Diabetes Mellitus Using Hybrid Closed-Loop and Predictive Low-Glucose Suspend Insulin Pump Treatments.

Insulin pumps coupled with continuous glucose monitoring sensors use algorithms to analyze real-time blood glucose levels. This allows for the suspension of insulin administration before hypoglycemic thresholds are reached or for adaptive tuning in hybrid closed-loop systems. This longitudinal retrospective study aims to analyze real-world glycemic outcomes in a pediatric population transitioning to such devices. We evaluated children with type 1 diabetes mellitus (T1D) admitted to the Pediatric Diabetes Department from a major University Hospital in Bucharest, Romania, who transitioned to hybrid closed-loop or predictive low-glucose suspend system from either non-automated insulin pumps or multiple daily injections. The primary outcome was assessing the change in glycated hemoglobin (HbA1c) after initiating these devices. Secondary outcomes analyzed changes in glucose metrics from the 90 days prior to the baseline and follow-up visit. 51 children were included (58.8% girls), the mean age was 10.3 ± 3.7 years, and the mean follow-up duration was 13.2 ± 4.5 months. The analyzed parameters, such as HbA1c (6.9 ± 0.7% vs. 6.7 ± 0.6%, p = 0.023), time in range (69.3 ± 11.2% vs. 76 ± 9.9%, p < 0.001), time in tight range (47.4 ± 10.9% vs. 53.7 ± 10.7%, p < 0.001), time below range (5.6 ± 2.9% vs. 3.5 ± 1.9%, p < 0.001), time above range (25 ± 11.2% vs. 20.4 ± 9.4%, p = 0.001), and coefficient of variation (37.9 ± 4.8% vs. 35.6 ± 4.6%, p = 0.001), showed significant improvements. The application of these sensor-integrated insulin pumps can significantly enhance metabolic control in pediatric populations, minimizing glycemic variations to mitigate complications and enrich the quality of life.

Prediction of insulin requirements by explainable machine learning for individuals with type 1 diabetes.

Adverse events related to insulin therapy remain common in individuals with type 1 diabetes. Optimization of insulin dose can reduce the frequency of these events and help to prevent macrovascular and microvascular complications. The aim of the present study was to develop machine learning models to predict the total daily dose (TDD) of insulin on the basis of data available in routine clinical practice, to evaluate the performance of the models, and to interpret the relation between its predictions and features. This retrospective observational study conducted at a single center recruited individuals diagnosed with type 1 diabetes who visited Kobe University Hospital and used continuous glucose monitoring in combination with continuous subcutaneous insulin infusion between 1 April 2010 and 29 February 2024. We developed TDD prediction models based on machine learning and evaluated its performance on the basis of the mean absolute percentage error (MAPE). Explainable artificial intelligence frameworks were applied to the machine learning model to facilitate interpretability. A total of 110 individuals with type 1 diabetes was included in the study. The best-performing model, the Random Forest, achieved a MAPE of 19.8%. The most important feature of the model for prediction of the TDD of insulin was body weight, followed by waist circumference and carbohydrate intake. We here developed machine learning models that predict the TDD of insulin from clinical information. Such models could contribute to the treatment of many individuals undergoing insulin therapy, with further developments being warranted.

Original Research: Exploring the Use of Passive vs. Active Insulin Safety Pen Needle Devices in a Pediatric Population: A Feasibility Study.

Insulin pens are the mainstay of insulin delivery in the pediatric population, especially among patients unable to use an insulin pump. Safety pen needle (SPN) devices have been embraced by both nurses and patients because they limit the risks of needlestick injury and exposure to blood-borne pathogens. With the commonly used traditional passive SPN device, however, it can be difficult to observe that the dose has been accurately or fully administered. The purpose of this study was to determine nurses' perceptions about the feasibility of using an active SPN device (specifically the Unifine SafeControl insulin pen needle), compared with the currently used passive SPN device, in pediatric patients ages 21 years or younger who require subcutaneous insulin injections. This feasibility study was conducted on a pediatric inpatient unit at 1 pediatric hospital in the southeastern United States. A total of 49 RNs completed both a pre-device change survey regarding the currently used passive SPN device and a post-device change survey regarding the active SPN device. The RNs also completed daily evaluations assessing the ease of teaching patients and their caregivers how to use the active SPN device. Participation consent was also obtained for 132 pediatric patients with diabetes who were admitted to the unit. The majority of the RNs (87.8%) reported overall satisfaction with the active SPN device, compared to about half (52.7%) who reported overall satisfaction with the passive SPN device. Almost all the RNs (98.6%) reported that the active SPN device was easy or very easy to use. Nearly all the nurses (93.9%) reported feeling completely or very confident that the active SPN device allowed them to deliver the full intended dose; and nearly all reported that it was easy or very easy to teach patients (98.2%) and their caregivers (96.4%) how to use the active device. As frontline workers in patient care, nurses can lead the innovation and development of new treatment approaches, protocols, and equipment. This nurse-led study explored the nurses' perceptions about the feasibility of a new active SPN device versus the passive SPN device in terms of safety, ease of use, ease of and confidence in dose administration, and ease of teaching device use to pediatric patients and their caregivers. The RNs' clear preference for the active over the passive SPN device suggests that the newer, active devices warrant more widespread use in hospital settings, with further research also recommended.