REVIEW  MANAGEMENT OF THE MAIN ENDOCRINE AND DIABETIC DISORDERS IN CHILDREN 

Minerva Pediatrica 2020 August;72(4):263-77

DOI: 10.23736/S0026-4946.20.05865-X

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

New technical approach to the diabetes therapy

Klemen DOVC ^{1, 2}, Tadej BATTELINO ^{1, 2} ✉

¹ Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, University Children’s Hospital, Ljubljana, Slovenia; ² Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia

Optimal glycemic control remains challenging in individuals with type 1 diabetes. With the comprehensive clinical evidence on safety and efficiency, the adoption of continuous glucose monitoring (CGM), insulin pumps, and control algorithms merging the two into closed-loop systems is rapidly increasing. Particularly the CGM and intermittently scanned CGM improved diabetes management outcomes in large populations. A meaningful translation from clinical trials in highly controlled settings to numerous evaluations of closed-loop technology in the unrestricted home environment ended with its commercialization and use in routine clinical practice. Although it is still not a cure, the closed-loop currently seems to be the most promising advancement in the treatment of diabetes, with promising results also reported from routine clinical practice in children and adults with type 1 diabetes. We summarize different aspects of a technological approach to diabetes care, list currently available devices and systems in the pipeline, and the key supporting clinical evidence for their use. We consider human factors associated with technology use and the importance of health economics to support implementation and reimbursement.

KEY WORDS: Pancreas, artificial; Blood glucose self-monitoring; Multiple daily injections; Diabetes Mellitus, type 1