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Hybrid closed-loop therapy: Where are we in 2021?
Lalantha Leelarathna1,2, Pratik Choudhary3, Emma G Wilmot4,5
1Diabetes, Endocrinology and Metabolism Centre, Manchester University NHS Foundation Trust, Manchester, UK.
Diabetes, Obesity & Metabolism
|December 3, 2020
Summary
Hybrid closed-loop systems combine automated insulin delivery with manual boluses for type 1 diabetes management. These advanced systems improve glucose control and reduce hypoglycemia risk, with specific features varying by model.
Area of Science:
- Endocrinology
- Biomedical Engineering
- Diabetes Technology
Background:
- Hybrid closed-loop systems represent the most advanced insulin delivery for type 1 diabetes.
- These systems integrate automated insulin delivery with manual mealtime boluses.
- Proper use enhances glucose control and minimizes hypoglycemia risk.
Purpose of the Study:
- Compare currently available commercial hybrid closed-loop systems in the UK.
- Evaluate Medtronic 670G/780G, Tandem t:slim X2 Control IQ, and CamAPS FX systems.
- Provide consensus recommendations for optimal use and decision-making.
Main Methods:
- Comparative analysis of three leading hybrid closed-loop systems.
- Review of sensor technology (Guardian 3 vs. Dexcom G6) and algorithm integration (pump vs. app).
- Assessment of clinical performance data from pivotal studies.
Main Results:
- Systems achieve 65-76% time in target glucose range (3.9-10 mmol/L) with low hypoglycemia.
- Medtronic uses Guardian 3 (7-day, multiple calibrations); Tandem/CamAPS use Dexcom G6 (10-day, calibration-free).
- CamAPS offers customizable targets and is licensed for pregnancy; Tandem has a night-time target.
Conclusions:
- User and healthcare professional education is crucial for system optimization and troubleshooting.
- Consensus recommendations aim to guide informed decisions on hybrid closed-loop system adoption.
- These systems offer significant benefits for type 1 diabetes management but require tailored approaches.
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