TY - JOUR
T1 - Utility and precision evidence of technology in the treatment of type 1 diabetes
T2 - a systematic review
AU - Jacobsen, Laura M.
AU - Sherr, Jennifer L.
AU - Considine, Elizabeth
AU - Chen, Angela
AU - Peeling, Sarah M.
AU - Hulsmans, Margo
AU - Charleer, Sara
AU - Urazbayeva, Marzhan
AU - Tosur, Mustafa
AU - Alamarie, Selma
AU - Redondo, Maria J.
AU - Hood, Korey K.
AU - Gottlieb, Peter A.
AU - Gillard, Pieter
AU - Wong, Jessie J.
AU - Hirsch, Irl B.
AU - Pratley, Richard E.
AU - Laffel, Lori M.
AU - Mathieu, Chantal
AU - ADA/EASD PMDI
A2 - Vilsbøll, Tina
A2 - Loos, Ruth J.F.
A2 - Njølstad, Pål Rasmus
A2 - Nakabuye, Mariam
A2 - Hansen, Torben
A2 - Guasch-Ferré, Marta
A2 - Clemmensen, Christoffer
A2 - Andersen, Mette K.
A2 - Thuesen, Anne Cathrine B.
A2 - Merino, Jordi
N1 - Publisher Copyright:
© The Author(s) 2023.
PY - 2023
Y1 - 2023
N2 - 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: 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: 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: 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.
AB - 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: 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: 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: 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.
U2 - 10.1038/s43856-023-00358-x
DO - 10.1038/s43856-023-00358-x
M3 - Journal article
C2 - 37794113
AN - SCOPUS:85173549199
VL - 3
JO - Communications Medicine
JF - Communications Medicine
SN - 2730-664X
IS - 1
M1 - 132
ER -