Page 278 - Glucose Monitoring Devices

References 285

Summary and conclusions
Tight glycemic management is challenging because of an increased risk for hypo-
glycemia, which can result in seizures, coma or other serious complications. Fear
of hypoglycemia is a significant obstacle for optimal glycemic control for both
patients with T1D and their families. To optimize blood glucose control, automated
insulin delivery systems were introduced. Following the introduction of LGS
systems, PLGS systems were successful in the reduction of hypoglycemic episodes.
In this chapter, we reviewed the development of the algorithms that automati-
cally suspend insulin delivery to minimize the number and duration of hypoglyce-
mic episodes. Both Medtronic PLGS system (MiniMed 640G) and Tandem
Basal-IQ have been tested in clinical trials that showed a significant reduction in
hypoglycemia without a significant increase in HbA1c. Moving forward with the
advancement in automated insulin delivery and hybrid closed-loop systems, reduc-
tion of nocturnal hypoglycemia, improvement in the overnight glycemic control, and
increase in overnight time in the range have been the main advantages for the pa-
tients with T1D. The controller in hybrid closed-loop systems adjusts insulin dosing
based on data from CGM devices. A meal announcement is still a requirement. The
management of postprandial glucose excursions and postexercise hypoglycemia
remain challenging. Further studies testing a fully closed-loop system to assess
the safety and efficacy of the systems in a free-living environment is necessary.

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