Utility and precision evidence of technology in the treatment of type 1 diabetes: a systematic review.
Journal
Communications medicine
ISSN: 2730-664X
Titre abrégé: Commun Med (Lond)
Pays: England
ID NLM: 9918250414506676
Informations de publication
Date de publication:
05 Oct 2023
05 Oct 2023
Historique:
received:
28
04
2023
accepted:
15
09
2023
medline:
5
10
2023
pubmed:
5
10
2023
entrez:
4
10
2023
Statut:
epublish
Résumé
The greatest change in the treatment of people living with type 1 diabetes in the last decade has been the explosion of technology assisting in all aspects of diabetes therapy, from glucose monitoring to insulin delivery and decision making. As such, the aim of our systematic review was to assess the utility of these technologies as well as identify any precision medicine-directed findings to personalize care. Screening of 835 peer-reviewed articles was followed by systematic review of 70 of them (focusing on randomized trials and extension studies with ≥50 participants from the past 10 years). We find that novel technologies, ranging from continuous glucose monitoring systems, insulin pumps and decision support tools to the most advanced hybrid closed loop systems, improve important measures like HbA1c, time in range, and glycemic variability, while reducing hypoglycemia risk. Several studies included person-reported outcomes, allowing assessment of the burden or benefit of the technology in the lives of those with type 1 diabetes, demonstrating positive results or, at a minimum, no increase in self-care burden compared with standard care. Important limitations of the trials to date are their small size, the scarcity of pre-planned or powered analyses in sub-populations such as children, racial/ethnic minorities, people with advanced complications, and variations in baseline glycemic levels. In addition, confounders including education with device initiation, concomitant behavioral modifications, and frequent contact with the healthcare team are rarely described in enough detail to assess their impact. Our review highlights the potential of technology in the treatment of people living with type 1 diabetes and provides suggestions for optimization of outcomes and areas of further study for precision medicine-directed technology use in type 1 diabetes. In the last decade, there have been significant advances in how technology is used in the treatment of people living with type 1 diabetes. These technologies primarily aim to help manage blood sugar levels. Here, we reviewed research published over the last decade to evaluate the impact of such technologies on type 1 diabetes treatment. We find that various types of novel technologies, such as devices to monitor blood sugar levels continuously or deliver insulin, improve important diabetes-related measures and can reduce the risk of having low blood sugar levels. Importantly, several studies showed a positive impact of technologies on quality of life in people living with diabetes. Our findings highlight the benefits of novel technologies in the treatment of type 1 diabetes and identify areas for further research to optimize and personalize diabetes care.
Sections du résumé
BACKGROUND
BACKGROUND
The greatest change in the treatment of people living with type 1 diabetes in the last decade has been the explosion of technology assisting in all aspects of diabetes therapy, from glucose monitoring to insulin delivery and decision making. As such, the aim of our systematic review was to assess the utility of these technologies as well as identify any precision medicine-directed findings to personalize care.
METHODS
METHODS
Screening of 835 peer-reviewed articles was followed by systematic review of 70 of them (focusing on randomized trials and extension studies with ≥50 participants from the past 10 years).
RESULTS
RESULTS
We find that novel technologies, ranging from continuous glucose monitoring systems, insulin pumps and decision support tools to the most advanced hybrid closed loop systems, improve important measures like HbA1c, time in range, and glycemic variability, while reducing hypoglycemia risk. Several studies included person-reported outcomes, allowing assessment of the burden or benefit of the technology in the lives of those with type 1 diabetes, demonstrating positive results or, at a minimum, no increase in self-care burden compared with standard care. Important limitations of the trials to date are their small size, the scarcity of pre-planned or powered analyses in sub-populations such as children, racial/ethnic minorities, people with advanced complications, and variations in baseline glycemic levels. In addition, confounders including education with device initiation, concomitant behavioral modifications, and frequent contact with the healthcare team are rarely described in enough detail to assess their impact.
CONCLUSIONS
CONCLUSIONS
Our review highlights the potential of technology in the treatment of people living with type 1 diabetes and provides suggestions for optimization of outcomes and areas of further study for precision medicine-directed technology use in type 1 diabetes.
In the last decade, there have been significant advances in how technology is used in the treatment of people living with type 1 diabetes. These technologies primarily aim to help manage blood sugar levels. Here, we reviewed research published over the last decade to evaluate the impact of such technologies on type 1 diabetes treatment. We find that various types of novel technologies, such as devices to monitor blood sugar levels continuously or deliver insulin, improve important diabetes-related measures and can reduce the risk of having low blood sugar levels. Importantly, several studies showed a positive impact of technologies on quality of life in people living with diabetes. Our findings highlight the benefits of novel technologies in the treatment of type 1 diabetes and identify areas for further research to optimize and personalize diabetes care.
Autres résumés
Type: plain-language-summary
(eng)
In the last decade, there have been significant advances in how technology is used in the treatment of people living with type 1 diabetes. These technologies primarily aim to help manage blood sugar levels. Here, we reviewed research published over the last decade to evaluate the impact of such technologies on type 1 diabetes treatment. We find that various types of novel technologies, such as devices to monitor blood sugar levels continuously or deliver insulin, improve important diabetes-related measures and can reduce the risk of having low blood sugar levels. Importantly, several studies showed a positive impact of technologies on quality of life in people living with diabetes. Our findings highlight the benefits of novel technologies in the treatment of type 1 diabetes and identify areas for further research to optimize and personalize diabetes care.
Identifiants
pubmed: 37794113
doi: 10.1038/s43856-023-00358-x
pii: 10.1038/s43856-023-00358-x
pmc: PMC10550996
doi:
Types de publication
Journal Article
Langues
eng
Pagination
132Subventions
Organisme : NIDDK NIH HHS
ID : P30 DK116073
Pays : United States
Organisme : NIDDK NIH HHS
ID : P30 DK036836
Pays : United States
Organisme : NIDDK NIH HHS
ID : P30 DK045735
Pays : United States
Organisme : NIDDK NIH HHS
ID : K08 DK128628
Pays : United States
Organisme : NIDDK NIH HHS
ID : K23 DK121771
Pays : United States
Organisme : NIDDK NIH HHS
ID : P30 DK116074
Pays : United States
Organisme : Wellcome Trust
ID : 210752/Z/18/Z
Pays : United Kingdom
Organisme : NIDDK NIH HHS
ID : P30 DK017047
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR001863
Pays : United States
Organisme : NIDDK NIH HHS
ID : K23 DK129821
Pays : United States
Investigateurs
Deirdre K Tobias
(DK)
Jordi Merino
(J)
Abrar Ahmad
(A)
Catherine Aiken
(C)
Jamie L Benham
(JL)
Dhanasekaran Bodhini
(D)
Amy L Clark
(AL)
Kevin Colclough
(K)
Rosa Corcoy
(R)
Sara J Cromer
(SJ)
Daisy Duan
(D)
Jamie L Felton
(JL)
Ellen C Francis
(EC)
Véronique Gingras
(V)
Romy Gaillard
(R)
Eram Haider
(E)
Alice Hughes
(A)
Jennifer M Ikle
(JM)
Anna R Kahkoska
(AR)
Jarno L T Kettunen
(JLT)
Raymond J Kreienkamp
(RJ)
Lee-Ling Lim
(LL)
Jonna M E Männistö
(JME)
Robert Massey
(R)
Niamh-Maire Mclennan
(NM)
Rachel G Miller
(RG)
Mario Luca Morieri
(ML)
Jasper Most
(J)
Rochelle N Naylor
(RN)
Bige Ozkan
(B)
Kashyap Amratlal Patel
(KA)
Scott J Pilla
(SJ)
Katsiaryna Prystupa
(K)
Sridaran Raghaven
(S)
Mary R Rooney
(MR)
Martin Schön
(M)
Zhila Semnani-Azad
(Z)
Magdalena Sevilla-Gonzalez
(M)
Pernille Svalastoga
(P)
Wubet Worku Takele
(WW)
Claudia Ha-Ting Tam
(CH)
Anne Cathrine B Thuesen
(ACB)
Mustafa Tosur
(M)
Amelia S Wallace
(AS)
Caroline C Wang
(CC)
Jessie J Wong
(JJ)
Jennifer M Yamamoto
(JM)
Katherine Young
(K)
Chloé Amouyal
(C)
Mette K Andersen
(MK)
Maxine P Bonham
(MP)
Mingling Chen
(M)
Feifei Cheng
(F)
Tinashe Chikowore
(T)
Sian C Chivers
(SC)
Christoffer Clemmensen
(C)
Dana Dabelea
(D)
Adem Y Dawed
(AY)
Aaron J Deutsch
(AJ)
Laura T Dickens
(LT)
Linda A DiMeglio
(LA)
Monika Dudenhöffer-Pfeifer
(M)
Carmella Evans-Molina
(C)
María Mercè Fernández-Balsells
(MM)
Hugo Fitipaldi
(H)
Stephanie L Fitzpatrick
(SL)
Stephen E Gitelman
(SE)
Mark O Goodarzi
(MO)
Jessica A Grieger
(JA)
Marta Guasch-Ferré
(M)
Nahal Habibi
(N)
Torben Hansen
(T)
Chuiguo Huang
(C)
Arianna Harris-Kawano
(A)
Heba M Ismail
(HM)
Benjamin Hoag
(B)
Randi K Johnson
(RK)
Angus G Jones
(AG)
Robert W Koivula
(RW)
Aaron Leong
(A)
Gloria K W Leung
(GKW)
Ingrid M Libman
(IM)
Kai Liu
(K)
S Alice Long
(SA)
William L Lowe
(WL)
Robert W Morton
(RW)
Ayesha A Motala
(AA)
Suna Onengut-Gumuscu
(S)
James S Pankow
(JS)
Maleesa Pathirana
(M)
Sofia Pazmino
(S)
Dianna Perez
(D)
John R Petrie
(JR)
Camille E Powe
(CE)
Alejandra Quinteros
(A)
Rashmi Jain
(R)
Debashree Ray
(D)
Mathias Ried-Larsen
(M)
Zeb Saeed
(Z)
Vanessa Santhakumar
(V)
Sarah Kanbour
(S)
Sudipa Sarkar
(S)
Gabriela S F Monaco
(GSF)
Denise M Scholtens
(DM)
Elizabeth Selvin
(E)
Wayne Huey-Herng Sheu
(WH)
Cate Speake
(C)
Maggie A Stanislawski
(MA)
Nele Steenackers
(N)
Andrea K Steck
(AK)
Norbert Stefan
(N)
Julie Støy
(J)
Rachael Taylor
(R)
Sok Cin Tye
(SC)
Gebresilasea Gendisha Ukke
(GG)
Marzhan Urazbayeva
(M)
Bart Van der Schueren
(B)
Camille Vatier
(C)
John M Wentworth
(JM)
Wesley Hannah
(W)
Sara L White
(SL)
Gechang Yu
(G)
Yingchai Zhang
(Y)
Shao J Zhou
(SJ)
Jacques Beltrand
(J)
Michel Polak
(M)
Ingvild Aukrust
(I)
Elisa de Franco
(E)
Sarah E Flanagan
(SE)
Kristin A Maloney
(KA)
Andrew McGovern
(A)
Janne Molnes
(J)
Mariam Nakabuye
(M)
Pål Rasmus Njølstad
(PR)
Hugo Pomares-Millan
(H)
Michele Provenzano
(M)
Cécile Saint-Martin
(C)
Cuilin Zhang
(C)
Yeyi Zhu
(Y)
Sungyoung Auh
(S)
Russell de Souza
(R)
Andrea J Fawcett
(AJ)
Chandra Gruber
(C)
Eskedar Getie Mekonnen
(EG)
Emily Mixter
(E)
Diana Sherifali
(D)
Robert H Eckel
(RH)
John J Nolan
(JJ)
Louis H Philipson
(LH)
Rebecca J Brown
(RJ)
Liana K Billings
(LK)
Kristen Boyle
(K)
Tina Costacou
(T)
John M Dennis
(JM)
Jose C Florez
(JC)
Anna L Gloyn
(AL)
Maria F Gomez
(MF)
Peter A Gottlieb
(PA)
Siri Atma W Greeley
(SAW)
Kurt Griffin
(K)
Andrew T Hattersley
(AT)
Marie-France Hivert
(MF)
Jami L Josefson
(JL)
Soo Heon Kwak
(SH)
Siew S Lim
(SS)
Ruth J F Loos
(RJF)
Ronald C W Ma
(RCW)
Nestoras Mathioudakis
(N)
James B Meigs
(JB)
Shivani Misra
(S)
Viswanathan Mohan
(V)
Rinki Murphy
(R)
Richard Oram
(R)
Katharine R Owen
(KR)
Susan E Ozanne
(SE)
Ewan R Pearson
(ER)
Wei Perng
(W)
Toni I Pollin
(TI)
Rodica Pop-Busui
(R)
Leanne M Redman
(LM)
Maria J Redondo
(MJ)
Rebecca M Reynolds
(RM)
Robert K Semple
(RK)
Emily K Sims
(EK)
Arianne Sweeting
(A)
Tiinamaija Tuomi
(T)
Miriam S Udler
(MS)
Kimberly K Vesco
(KK)
Tina Vilsbøll
(T)
Robert Wagner
(R)
Stephen S Rich
(SS)
Paul W Franks
(PW)
Informations de copyright
© 2023. Springer Nature Limited.
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