Hybrid closed-loop systems for the treatment of type 1 diabetes : a collaborative, expert group position statement for clinical use in Central and Eastern Europe

Janež, Andrej (author), Battelino, Tadej (author), Klupa, Tomasz Klupa (author), Kocsis, Győző (author), Kuricová, Miriam (author), Lalić, Nebojsa M. (author), Pantea Stoian, Anca (author), Prázný, Martin (author), Rahelić, Dario (author), Šoupal, Jan (author), Tankova, Tsvetalina (author), Zelinska, Nataliya (author)

In both pediatric and adult populations with type 1 diabetes (T1D), technologies such as continuous subcutaneous insulin infusion (CSII), continuous glucose monitoring (CGM), or sensor-augmented pumps (SAP) can consistently improve glycemic control [measured as glycated hemoglobin (HbA1c) and time in range (TIR)] while reducing the risk of hypoglycemia. Use of technologies can thereby improve quality of life and reduce the burden of diabetes management compared with self-injection of multiple daily insulin doses (MDI). Novel hybrid closed-loop (HCL) systems represent the latest treatment modality for T1D, combining modern glucose sensors and insulin pumps with a linked control algorithm to offer automated insulin delivery in response to blood glucose levels and trends. HCL systems have been associated with increased TIR, improved HbA1c, and fewer hypoglycemic events compared with CSII, SAP, and MDI, thereby potentially improving quality of life for people with diabetes (PwD) while reducing the costs of treating short- and long-term diabetes-related complications. However, many barriers to their use and regional inequalities remain in Central and Eastern Europe (CEE). Published data suggest that access to diabetes technologies is hindered by lack of funding, underdeveloped health technology assessment (HTA) bodies and guidelines, unfamiliarity with novel therapies, and inadequacies in healthcare system capacities. To optimize the use of diabetes technologies in CEE, an international meeting comprising experts in the field of diabetes was held to map the current regional access, to present the current national reimbursement guidelines, and to recommend solutions to overcome uptake barriers. Recommendations included regional and national development of HTA bodies, efficient allocation of resources, and structured education programs for healthcare professionals and PwD. The responsibility of the healthcare community to ensure that all individuals with T1D gain access to modern technologies in a timely and economically responsible manner, thereby improving health outcomes, was emphasized, particularly for interventions that are cost-effective.

• Language: English
• Keywords: hybrid closed loop, advanced hybrid closed-loop, type 1 diabetes, Central and Eastern Europe, position statement
• Work type: Article
• Typology: 1.01 - Original Scientific Article
• Organization: MF - Faculty of Medicine
• Publication status: Published
• Publication version: Version of Record
• Year: 2021
• Number of pages: Str. 3107-3135
• Numbering: Vol. 12, iss. 12
• PID: 20.500.12556/RUL-134828
• UDC: 616.379
• ISSN on article: 1869-6961
• DOI: 10.1007/s13300-021-01160-5
• COBISS.SI-ID: 80055043
• Publication date in RUL: 03.02.2022

Record is a part of a journal

• Title: Diabetes therapy
• Shortened title: Diabetes ther.
• Publisher: Springer Nature
• ISSN: 1869-6961
• COBISS.SI-ID: 520452889

Licences

• License: CC BY-NC 4.0, Creative Commons Attribution-NonCommercial 4.0 International
• Link: http://creativecommons.org/licenses/by-nc/4.0/
• Description: A creative commons license that bans commercial use, but the users don’t have to license their derivative works on the same terms.
• Licensing start date: 25.10.2021

Secondary language

• Language: Slovenian
• Keywords: hibridna zaprta zanka, sladkorna bolezen tipa 1, srednja in vzhodna Evropa

Projects

• Funder: Other - Other funder or multiple funders
• Funding programme: Medtronic International Trading Sarl