Sensor-augmented Insulin Pump Research Articles

Evidence-informed clinical practice recommendations for treatment of type 1 diabetes complicated by problematic hypoglycemia.

Problematic hypoglycemia, defined as two or more episodes per year of severe hypoglycemia or as one episode associated with impaired awareness of hypoglycemia, extreme glycemic lability, or major fear and maladaptive behavior, is a challenge, especially for patients with long-standing type 1 diabetes. Individualized therapy for such patients should include a composite target: optimal glucose control without problematic hypoglycemia. Therefore, we propose a tiered, four-stage algorithm based on evidence of efficacy given the limitations of educational, technological, and transplant interventions. All patients with problematic hypoglycemia should undergo structured or hypoglycemia-specific education programs (stage 1). Glycemic and hypoglycemia treatment targets should be individualized and reassessed every 3-6 months. If targets are not met, one diabetes technology-continuous subcutaneous insulin infusion or continuous glucose monitoring-should be added (stage 2). For patients with continued problematic hypoglycemia despite education (stage 1) and one diabetes technology (stage 2), sensor-augmented insulin pumps preferably with an automated low-glucose suspend feature and/or very frequent contact with a specialized hypoglycemia service can reduce hypoglycemia (stage 3). For patients whose problematic hypoglycemia persists, islet or pancreas transplant should be considered (stage 4). This algorithm provides an evidence-informed approach to resolving problematic hypoglycemia; it should be used as a guide, with individual patient circumstances directing suitability and acceptability to ensure the prudent use of technology and scarce transplant resources. Standardized reporting of hypoglycemia outcomes and inclusion of patients with problematic hypoglycemia in studies of new interventions may help to guide future therapeutic strategies.

New technologies in diabetology. How far are we from a closed loop?

Today, assistive technologies are highly important in the treatment of diabetes, especially in the therapy of type 1 diabetes. The use of insulin pumps, for example, has become an established form of treatment. Modern insulin pumps offer various functions, such as different basal rate profiles, split delivery of the meal bolus, and integrated bolus calculators. Some pumps are additionally connected to a blood glucose meter or a continuous glucose-monitoring sensor. Several minimally invasive needle-type sensor systems for continuous tissue glucose monitoring are already available. Recent developments aim at increasing the functionality of insulin pumps and the improvements of sensors for continuous glucose monitoring. In addition, many research groups are working on closing the loop between these two components and thus developing an artificial pancreas, which automatically regulates insulin delivery. The first steps have already been taken and bolus calculators or sensor-augmented insulin pumps with suspension of insulin delivery are now available. Many experimental models show promising results. Prior to the implementation of a fully automated system for everyday use, however, partially automated systems that require user input are to be expected. This article aims at giving an overview of the current state of development in the field of diabetes technology.

Multinight "bedside" closed-loop control for patients with type 1 diabetes.

Studies of closed-loop control (CLC) systems have improved glucose levels in patients with type 1 diabetes. In this study we test a new CLC concept aiming to "reset" the patient overnight to near-normoglycemia each morning, for several consecutive nights. Ten insulin pump users with type 1 diabetes (mean age, 46.4±8.5 years) were enrolled in a two-center (in the United States and Italy) randomized crossover trial comparing 5 consecutive nights of CLC (23:00-07:00 h) in an outpatient setting versus sensor-augmented insulin pump therapy of the same duration at home. Primary end points included time spent in 80-140 mg/dL as measured by continuous glucose monitoring overnight and fasting blood glucose distribution at 7:00 h. Compared with sensor-augmented pump therapy, CLC improved significantly time spent between 80 and 140 mg/dL (54.5% vs. 32.2%; P<0.001) and between 70 and 180 mg/dL (85.4% vs. 59.1%; P<0.001); CLC reduced the mean glucose level at 07:00 h (119.3 vs. 152.9 mg/dL; P<0.001) and overnight mean glucose level (139.0 vs. 170.3 mg/dL; P<0.001) using a marginally lower amount of insulin (6.1 vs. 6.8 units; P=0.1). Tighter overnight control led to improved daytime control on the next day: the overnight/next-day control correlation was r=0.52, P<0.01. Multinight CLC of insulin delivery (artificial pancreas) results in significant improvement in morning and overnight glucose levels and time in target range, with the potential to improve daytime control when glucose levels were "reset" to near-normoglycemia each morning.

Impact of new technologies on diabetes care.

Technologies for diabetes management, such as continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) systems, have improved remarkably over the last decades. These developments are impacting the capacity to achieve recommended hemoglobin A1c levels and assisting in preventing the development and progression of micro- and macro vascular complications. While improvements in metabolic control and decreases in risk of severe and moderate hypoglycemia have been described with use of these technologies, large epidemiological international studies show that many patients are still unable to meet their glycemic goals, even when these technologies are used. This editorial will review the impact of technology on glycemic control, hypoglycemia and quality of life in children and youth with type 1 diabetes. Technologies reviewed include CSII, CGM systems and sensor-augmented insulin pumps. In addition, the usefulness of advanced functions such as bolus profiles, bolus calculators and threshold-suspend features will be also discussed. Moreover, the current editorial will explore the challenges of using these technologies. Indeed, despite the evidence currently available of the potential benefits of using advanced technologies in diabetes management, many patients still report barriers to using them. Finally this article will highlight the importance of future studies tailored toward overcome these barriers to optimizing glycemic control and avoiding severe hypoglycemia.

A Perspective of Sensor-Augmented Insulin Pump Therapy in The Treatment of Type 1 Diabetes

The holy grail for the treatment of type 1 diabetes is stem cell therapy (1,2) or the closed-loop artificial pancreas (3,4). Whereas several groups are currently developing these treatment modalities, we are not there yet. The first step in the process has been met with the low-glucose suspend pump, which stops insulin delivery for up to 2 hours when the interstitial glucose concentration reaches 70 mg/ dL (5). The Diabetes Control and Complications Trial first showed a clear relationship between diabetic microvascular complications and glycemic control (6).

Health-Economic Comparison of Sensor-Augmented Pump With Low Glucose Suspend Versus Insulin Pump Alone For The Treatment Of Hypo-Prone Type 1 Diabetes In Slovakia.

To project the long-term costs and outcomes of sensor-augmented pump (SAP) with low glucose suspend (LGS) versus insulin pump alone (CSII) for the treatment of hypo-prone Type 1 diabetes in Slovakia. The CORE Diabetes Model is a peer-reviewed, validated model, which employs standard Markov/Monte Carlo simulation techniques to describe the long-term incidence and progression of diabetes-related complications. It was used to simulate disease progression in a cohort of patients with baseline characteristics (mean age 18.6 years, duration of diabetes 12 years, mean HbA1c 7.5%) and clinical outcomes (severe hypoglycaemic event rates; Quality of Life; HbA1c) taken from a recent randomised controlled trial (Ly et al, 2013). Local treatment and complication cost data was used. The main scenario considered in this cost-effectiveness analysis was the comparison of sensor-augmented insulin pump (SAP) with low glucose suspend (LGS) versus insulin pump alone (CSII). The target population was type I hypo-prone diabetes patients with the analysis based on a deterministic microsimulation of 1,000 patients, using a 5 year time horizon. Direct costs were calculated from a third-party payer perspective. Discount rates of 3% per annum were applied to both costs and clinical outcomes. The Incremental-Cost-Effectiveness-Ratio (ICER) for SAP+LGS (vs CSII) was €17,893 per Quality-Adjusted-Life-Year gained over a 5 year time horizon. Results were similar across a 1 to 10 year time horizon. Other extensive sensitivity analyses showed the robustness of the results. Using a payer’s perspective, our analysis showed that SAP (w LGS) is cost-effective over a short term (5 year) time horizon in hypo-prone Type 1 Diabetes patients in Slovakia (using a WTP threshold of 1x [€18,000] or 3x [€54,000] Slovakia GDP).

Closed-Loop at night for the treatment of type 1 diabetes

This mini-review describes the latest efforts, challenges, and experience of using automated insulin delivery systems at outpatient settings and home studies. Predictive low glucose management (PLGM) may help prevent hypoglycemia by stopping insulin pump delivery based on predicted sensor glucose values. In silico modeling and early feasibility data demonstrate that PLGM may further reduce the severity of hypoglycemia beyond that already established for algorithms that use a threshold-based suspension. Recent studies have shown that an closed-loop system can improve glucose control and reduce nocturnal hypoglycemia. In the multinational, multicenter DREAM project patients at a diabetes camp who were treated with an artificial-pancreas system had less nocturnal hypoglycemia and tighter glucose control than when they were treated with a sensor-augmented insulin pump. Studies using closed-loop systems at patients' home are currently being carried out. The preliminary results of these experiments are encouraging and enhance our confidence in this tool as suitable for use in clinical daily practice.

Assessing the effectiveness of 3 months day and night home closed-loop insulin delivery in adults with suboptimally controlled type 1 diabetes: a randomised crossover study protocol.

IntroductionDespite therapeutic advances, many people with type 1 diabetes are still unable to achieve optimal glycaemic control, limited by the occurrence of hypoglycaemia. The objective of the present study is to determine the effectiveness of day and night home closed-loop over the medium term compared with sensor-augmented pump therapy in adults with type 1 diabetes and suboptimal glycaemic control.Methods and analysisThe study will adopt an open label, three-centre, multinational, randomised, two-period crossover study design comparing automated closed-loop glucose control with sensor augmented insulin pump therapy. The study will aim for 30 completed participants. Eligible participants will be adults (≥18 years) with type 1 diabetes treated with insulin pump therapy and suboptimal glycaemic control (glycated haemoglobin (HbA1c) ≥7.5% (58 mmol/mmol) and ≤10% (86 mmol/mmol)). Following a 4-week optimisation period, participants will undergo a 3-month use of automated closed-loop insulin delivery and sensor-augmented pump therapy, with a 4–6 week washout period in between. The order of the interventions will be random. All analysis will be conducted on an intention to treat basis. The primary outcome is the time spent in the target glucose range from 3.9 to 10.0 mmol/L based on continuous glucose monitoring levels during the 3 months free living phase. Secondary outcomes include HbA1c changes; mean glucose and time spent above and below target glucose levels. Further, participants will be invited at baseline, midpoint and study end to participate in semistructured interviews and complete questionnaires to explore usability and acceptance of the technology, impact on quality of life and fear of hypoglycaemia.Ethics and disseminationEthical approval has been obtained at all sites. Before screening, all participants will be provided with oral and written information about the trial. The study will be disseminated by peer-review publications and conference presentations.Trial registration numberNCT01961622 (ClinicalTrials.gov).

A Cost-Effectiveness Analysis of Sensor-Augmented Insulin Pump Therapy and Automated Insulin Suspension versus Standard Pump Therapy for Hypoglycemic Unaware Patients with Type 1 Diabetes

ObjectiveTo assess the cost-effectiveness of sensor-augmented insulin pump therapy with “Low Glucose Suspend” (LGS) functionality versus standard pump therapy with self-monitoring of blood glucose in patients with type 1 diabetes who have impaired awareness of hypoglycemia. MethodsA clinical trial–based economic evaluation was performed in which the net costs and effectiveness of the two treatment modalities were calculated and expressed as an incremental cost-effectiveness ratio (ICER). The clinical outcome of interest for the evaluation was the rate of severe hypoglycemia in each arm of the LGS study. Quality-of-life utility scores were calculated using the three-level EuroQol five-dimensional questionnaire. Resource use costs were estimated using public sources. ResultsAfter 6 months, the use of sensor-augmented insulin pump therapy with LGS significantly reduced the incidence of severe hypoglycemia compared with standard pump therapy (incident rate difference 1.85 [0.17–3.53]; P = 0.037). Based on a primary randomized study, the ICER per severe hypoglycemic event avoided was $18,257 for all patients and $14,944 for those aged 12 years and older. Including all major medical resource costs (e.g., hospital admissions), the ICERs were $17,602 and $14,289, respectively. Over the 6-month period, the cost per quality-adjusted life-year gained was $40,803 for patients aged 12 years and older. ConclusionsBased on the Australian experience evaluating new interventions across a broad range of therapeutic areas, sensor-augmented insulin pump therapy with LGS may be considered a cost-effective alternative to standard pump therapy with self-monitoring of blood glucose in hypoglycemia unaware patients with type 1 diabetes.

Day and Night Home Closed-Loop Insulin Delivery in Adults With Type 1 Diabetes: Three-Center Randomized Crossover Study

To evaluate the feasibility of day and night closed-loop insulin delivery in adults with type 1 diabetes under free-living conditions. Seventeen adults with type 1 diabetes on insulin pump therapy (means ± SD age 34 ± 9 years, HbA1c 7.6 ± 0.8%, and duration of diabetes 19 ± 9 years) participated in an open-label multinational three-center crossover study. In a random order, participants underwent two 8-day periods (first day at the clinical research facility followed by 7 days at home) of sensor-augmented insulin pump therapy (SAP) or automated closed-loop insulin delivery. The primary end point was the time when sensor glucose was in target range between 3.9 and 10.0 mmol/L during the 7-day home phase. During the home phase, the percentage of time when glucose was in target range was significantly higher during closed-loop compared with SAP (median 75% [interquartile range 61-79] vs. 62% [53-70], P = 0.005). Mean glucose (8.1 vs. 8.8 mmol/L, P = 0.027) and time spent above target (P = 0.013) were lower during closed loop, while time spent below target was comparable (P = 0.339). Increased time in target was observed during both daytime (P = 0.017) and nighttime (P = 0.013). Compared with SAP, 1 week of closed-loop insulin delivery at home reduces mean glucose and increases time in target without increasing the risk of hypoglycemia in adults with relatively well-controlled type 1 diabetes.

Quantitative Estimation of Insulin Sensitivity in Type 1 Diabetic Subjects Wearing a Sensor-Augmented Insulin Pump

OBJECTIVEThe goal was to develop a new index of insulin sensitivity in patients with type 1 diabetes estimated from continuous glucose monitoring (CGM) and subcutaneous insulin delivery data under carefully controlled conditions.RESEARCH DESIGN AND METHODSThe database consists of 12 subjects with type 1 diabetes, studied during breakfast, lunch, and dinner, in a clinical research unit, wearing both subcutaneous insulin pump and CGM device. Frequent blood samples were drawn for measurements of plasma glucose and insulin concentrations in order to estimate insulin sensitivity with the oral minimal model (SIMM). The new index of insulin sensitivity (SISP) was calculated with a simple algebraic formula for each meal, using only CGM and insulin pump data and compared with SIMM.RESULTSSISP was well correlated with SIMM (r = 0.825; P < 10−8), and diurnal pattern was also similar to SIMM.CONCLUSIONSA novel method for estimating insulin sensitivity in subjects with type 1 diabetes on sensor-augmented insulin pump therapy has been presented. This new index correlates well with the reference oral minimal model estimate of insulin sensitivity. The knowledge of patient-specific insulin sensitivity and its diurnal variation can help in optimizing insulin therapy in type 1 diabetes and could also inform next-generation closed-loop control systems.

Abstracts from ATTD 20147th International Conference on AdvancedTechnologies &amp; Treatments for DiabetesVienna, Austria, February 5–8, 2014

Introduction: Currently measures of glycaemic variability (Standard Deviation, Mean and MAGE) all fail to fully highlight the extent of blood glucose variability so there is a need for improved measures of glycaemic variability. Aim: To utilise clinical data produced using CGMS to develop and validate a clinically-relevant novel measure of glycaemic variability and to use it to compare CSII with MDI. Methods: 20 participants (6 months pre and post CSII) with 24 hr CGM data sets were analysed. Glucose variability Rating (GVR) was calculated in three steps including change in sensor reading at 5 minute intervals which were then squared and av- eraged to obtain GVR (mmol/L) 2/hr. GVR was plotted, area under curve (AUC) calculated and pre vs. post-CSII GVR compared. Time series analysis was also investigated to try and identify specific periods with increased variability. A compari- son of the percentage change in GVR vs the change in HbA1c value in pre vs post-CSII was also analysed to identify correla- tion between these two measures. Results: GVR was applied to pre and post-CSII CGM data; 75% of participants showed < 20% reduction of GVR post-CSII vs. MDI. The group also showed a significant reduction in GVR (p < 0.003) post-CSII (vs MDI). Conclusions: Results indicate a reduction in glucose vari- ability with CSII and highlight the limitations of HbA1c, as well as the useful potential of GVR to highlight specific time periods where intervention is required to control blood glucose variability.

Continuous Glucose Monitoring in 2013

Continuous glucose monitoring (CGM) in the pediatric population with type 1 diabetes (T1D) was somewhat infamously described as “satisfaction without success” (1); success with CGM is strongly related to its use, and children and adolescents in some countries seem to be particularly reluctant to use CGM devices regularly as the behavioral changes these devices force on them may not be desirable. However, the SWITCH randomized clinical trial clearly demonstrated that CGM can be as successful in adolescents as in adults with T1D. Despite this fact, the reimbursement for CGM in Europe is still far from universal (2) but growing steadily as data on its benefits accumulate. The use of retrospective (professional) CGM has expanded far beyond its initial indications. Also, type 2 diabetes (T2D) is becoming an important focus for both retrospective and real-time CGM. Finally, an important study demonstrated that the home use of threshold insulin suspend based on sensor-augmented insulin pump therapy in T1D can reduce and prevent hypoglycemia.

Insulin Therapy in Children and Adolescents with Type 1 Diabetes

Treatment of type 1 diabetes mellitus (T1DM) requires lifelong administration of exogenous insulin. The primary goal of treatment of T1DM in children and adolescents is to maintain near-normoglycemia through intensive insulin therapy, avoid acute complications, and prevent long-term microvascular and macrovascular complications, while facilitating as close to a normal life as possible. Effective insulin therapy must, therefore, be provided on the basis of the needs, preferences, and resources of the individual and the family for optimal management of T1DM. To achieve target glycemic control, the best therapeutic option for patients with T1DM is basal-bolus therapy either with multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII). Many formulations of insulin are available to help simulate endogenous insulin secretion as closely as possible in an effort to eliminate the symptoms and complications of hyperglycemia, while minimizing the risk of hypoglycemia secondary to therapy. When using MDI, basal insulin requirements are given as an injection of long- or intermediate-acting insulin analogs, while meal-related glucose excursions are controlled with bolus injections of rapid-acting insulin analogs. Alternatively, CSII can be used, which provides a 24-h preselected but adjustable basal rate of rapid-acting insulin, along with patient-activated mealtime bolus doses, eliminating the need for periodic injections. Both MDI treatment and CSII therapy must be supported by comprehensive education that is appropriate for the individual needs of the patient and family before and after initiation. Current therapies still do not match the endogenous insulin profile of pancreatic β-cells, and all still pose risks of suboptimal control, hypoglycemia, and ketosis in children and adolescents. The safety and success of a prescribed insulin regimen is, therefore, dependent on self-monitoring of blood glucose and/or a continuous glucose monitoring system to avoid critical hypoglycemia and glucose variability. Regardless of the mode of insulin therapy, doses should be adapted on the basis of the daily pattern of blood glucose, through regular review and reassessment, and patient factors such as exercise and pubertal status. New therapy options such as sensor-augmented insulin pump therapy, which integrates CSII with a continuous glucose sensor, along with emerging therapies such as the artificial pancreas, will likely continue to improve safe insulin therapy in the near future.

Narcolepsy with coexisting type 1 diabetes: a case report

Narcolepsy is strongly associated with HLA-DQB1∗06:02 which is protective for type 1 diabetes. The combination of these two diseases is extremely rare. Sodium oxybate (SXB) is an efficient treatment of narcolepsy. In a 24 year old Caucasian woman with suspected narcolepsy SXB increased hyperglycemia and ketosis. We report a case of a 15 year old Finnish boy with type 1 diabetes who developed narcolepsy and cataplexy after Pandemrix vaccination (PDRX). At age 12 the boy received PDRX and he developed excessive daytime sleepiness (EDS) 1 month later. Ambiguous cataplexy (CPL), sleep paralysis and hypnagogic hallucinations started 5 months after EDS and disturbed sleep 1 month after the vaccination. The TST was 400 min, sleep efficiency 82%, SL 3 min and REM latency 56 min. AHI was 0.3. MSLT SL was 0.75 min with 4/5 SOREM periods. He is HLA-DQA1∗03:01, 01:02 and DQB1∗03:02, 06:02. EDS was treated with modafinil, and CPL with clomipramine and later with venlafaxine 75 mg. SBX was started at age 15 because of disturbed night sleep and insufficient control of CPL. His diabetes was treated with a sensor-augmented insulin pump. SBX treatment started with 4 g (1.5 g × 2). Tissue glucose was followed continuously with the pump. No significant increase in glucose has been observed and SBX has been well tolerated. Presently he is treated with SBX 7.5 g, modafinil 200–300 mg and venlafaxine 75 mg. The BMI has decreased from 22.4 to 20.7 kg/m2, PDSS score from 20 to 12 and UNS from 15 to 5. WHO5 quality of life score has increased from 45% to 85%. HbA1c has decreased from 64 mmol/mol (8.0%) to 57 mmol/mol (7.4%) during treatment with SBX. A combination of narcolepsy (Brighton level 2) and type 1 diabetes is rare. Contrary to a previous case report SBX ameliorated glucose balance in addition to ameliorating narcolepsy. This study was supported by Academy of Finland (NARPANord, 260603). We thank study nurses of our sleep clinic and the courageous boy and his parents for collaboration.

PDB14 - Health Economic Benefits of Sensor Augmented Insulin Pump Therapy in Colombia

PDB14 - Health Economic Benefits of Sensor Augmented Insulin Pump Therapy in Colombia

PDB98 - Health-Related Quality of Life in Patients with Type 1 Diabetes and Impaired Hypoglycaemia Awareness: The Role of Sensor-Augmented Insulin Pump Therapy with Automated Insulin Suspension

PDB98 - Health-Related Quality of Life in Patients with Type 1 Diabetes and Impaired Hypoglycaemia Awareness: The Role of Sensor-Augmented Insulin Pump Therapy with Automated Insulin Suspension

Effect of Sensor-Augmented Insulin Pump Therapy and Automated Insulin Suspension vs Standard Insulin Pump Therapy on Hypoglycemia in Patients With Type 1 Diabetes

Hypoglycemia is a critical obstacle to the care of patients with type 1 diabetes. Sensor-augmented insulin pump with automated low-glucose insulin suspension has the potential to reduce the incidence of major hypoglycemic events. To determine the incidence of severe and moderate hypoglycemia with sensor-augmented pump with low-glucose suspension compared with standard insulin pump therapy. A randomized clinical trial involving 95 patients with type 1 diabetes, recruited from December 2009 to January 2012 in Australia. Patients were randomized to insulin pump only or automated insulin suspension for 6 months. The primary outcome was the combined incidence of severe (hypoglycemic seizure or coma) and moderate hypoglycemia (an event requiring assistance for treatment). In a subgroup, counterregulatory hormone responses to hypoglycemia were assessed using the hypoglycemic clamp technique. Of the 95 patients randomized, 49 were assigned to the standard-pump (pump-only) therapy and 46 to the low-glucose suspension group. The mean (SD) age was 18.6 (11.8) years; duration of diabetes, 11.0 (8.9) years; and duration of pump therapy, 4.1 (3.4) years. The baseline rate of severe and moderate hypoglycemic events in the pump-only group was 20.7 vs 129.6 events per 100 patient months in the low-glucose suspension group. After 6 months of treatment, the event rates decreased from 28 to 16 in the pump-only group vs 175 to 35 in the low-glucose suspension group. The adjusted incidence rate per 100 patient-months was 34.2 (95% CI, 22.0-53.3) for the pump-only group vs 9.5 (95% CI, 5.2-17.4) for the low-glucose suspension group. The incidence rate ratio was 3.6 (95% CI, 1.7-7.5; P <.001). There was no change in glycated hemoglobin in either group: mean, 7.4 (95% CI, 7.2-7.6) to 7.4 (95% CI, 7.2-7.7) in the pump-only group vs mean, 7.6 (95%, CI, 7.4-7.9) to 7.5 (95% CI, 7.3-7.7) in the low-glucose suspension group. Counterregulatory hormone responses to hypoglycemia were not changed. There were no episodes of diabetic ketoacidosis or hyperglycemia with ketosis. Sensor-augmented pump therapy with automated insulin suspension reduced the combined rate of severe and moderate hypoglycemia in patients with type 1 diabetes. anzctr.org.au Identifier: ACTRN12610000024044.

Technology to Optimize Pediatric Diabetes Management and Outcomes

Technology for diabetes management is rapidly developing and changing. With each new development, there are numerous factors to consider, including medical benefits, impact on quality of life, ease of use, and barriers to use. It is also important to consider the interaction between developmental stage and technology. This review considers a number of newer diabetes-related technologies and explores issues related to their use in the pediatric diabetes population (including young adults), with a focus on psychosocial factors. Areas include trend technology in blood glucose monitoring, continuous glucose monitoring, sensor-augmented insulin pumps and low glucose suspend functions, internet applications including videoconferencing, mobile applications (apps), text messaging, and online gaming.

Hypoglycemia and Blood Glucose Fluctuations in the Application of a Sensor-Augmented Insulin Pump

The purpose of this study was to understand the effect of sensor-augmented insulin pump (SAP) use on hypoglycemia and blood glucose (BG) fluctuations. Sixty patients with type 2 diabetes mellitus were randomly assigned to three groups of treatment with SAP, continuous subcutaneous insulin infusion (CSII), or multiple daily injection (MDI) therapy for 6 days. Parameters of glycemic control that were determined included mean BG concentration (MBG), SD of BG (SDBG), mean amplitude of glycemic excursions (MAGE), absolute means of daily differences (MODD), 24-h area under the curve at 10 h (AUC10), 24-h area under the curve at 3.9 h (AUC3.9), and Low Blood Glucose Index (LBGI). No significant differences were observed among the three groups in terms of MBG, SDBG, MAGE, or MODD at the beginning of treatment. The MBG, SDBG, MAGE, MODD, and total AUC10 of the SAP group improved over the 4 days of the intervention compared with the CSII and MDI groups; however, no significant differences were observed among the three groups in terms of total AUC3.9 and LBGI. Compared with CSII and MDI therapy, SAP therapy was able to rapidly lower mean BG and reduce BG level fluctuations with no increased risks of hypoglycemia.