ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2017) 51 S4.3 | DOI: 10.1530/endoabs.51.S4.3

Diabetes and technology. Current state of the art and future prospects

Carlo L Acerini

Department of Paediatrics, University Senior Lecturer, University of Cambridge, Cambridge, UK.

Advances in diabetes technology, particularly the introduction of continuous subcutaneous insulin infusion (CSII) pumps and of subcutaneous glucose sensing devices, have transformed the Type 1 diabetes (T1D) management landscape over the last 20 years. These devices have become more commonplace in our clinical practice, yet the evidence base that they have contributed to the modest improvements in glycaemic control in children and young people with T1D over these last two decades is far from certain. Data from a limited number of observational studies and small clinical trials of CSII therapy and of subcutaneous continuous glucose monitoring (CGM), used either alone or in combination (sensor augmented pump therapy), suggest that they are most effective at improving quality of life and in reducing the frequency of severe hypoglycaemia. Furthermore, meta-analysis of studies comparing ‘standard’ treatment approaches such as multiple daily injection (MDI) therapy and self-monitoring of blood glucose via finger pricks (SMBG) with CSII and CGM do not suggest that the latter result in sustained better glycaemic control over the short / medium term, and long term data are lacking. Observations from ‘real world’ data obtained from prospective, national diabetes registries are also at best equivocal. Integrating CSII and CGM technologies using control algorithms are likely to be more effective at maintaining blood glucose levels within the normal range. Low glucose suspend (LGS) and ‘predictive’ LGS set-ups are now commercially available and are the first steps towards developing fully ‘closed loop’ (artificial pancreas (AP)) systems, of which several AP systems are currently undergoing home based clinical trials. Although the role of current diabetes technologies in paediatric diabetes care are well established, ongoing research within this population is required not only to establish their clinical effectiveness and safety but, critically, also their acceptability, equity of access and cost-effectiveness for our patients and for our healthcare system.

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