Utility and precision evidence of technology in the treatment of type 1 diabetes: a systematic review

Authors

Laura M. Jacobsen, University of Florida
Jennifer L. Sherr, Yale School of Medicine
Elizabeth Considine, Yale School of Medicine
Angela Chen, University of Florida
Sarah M. Peeling, University of Florida
Margo Hulsmans, KU Leuven– University Hospital Leuven
Sara Charleer, KU Leuven– University Hospital Leuven
Marzhan Urazbayeva, Texas Children's Hospital
Mustafa Tosur, Texas Children's Hospital
Selma Alamarie, Stanford University School of Medicine
Maria J. Redondo, Texas Children's Hospital
Korey K. Hood, Stanford University School of Medicine
Peter A. Gottlieb, Barbara Davis Center for Diabetes
Pieter Gillard, KU Leuven– University Hospital Leuven
Jessie J. Wong, USDA Agricultural Research Service
Irl B. Hirsch, University of Washington School of Medicine
Richard E. Pratley, AdventHealth Translational Research Institute
Lori M. Laffel, Harvard Medical School
Chantal Mathieu, KU Leuven– University Hospital Leuven
Paul W. Franks, Harvard T.H. Chan School of Public Health
Stephen S. Rich, University of Virginia School of Medicine
Robert Wagner, Deutsches Diabetes-Zentrum
Tina Vilsbøll, Steno Diabetes Center Copenhagen
Kimberly K. Vesco, Kaiser Permanente Center for Health Research
Miriam S. Udler, Massachusetts General Hospital
Tiinamaija Tuomi, Helsinki University Hospital
Arianne Sweeting, Faculty of Medicine and Health
Emily K. Sims, Indiana University School of Medicine
Robert K. Semple, Edinburgh Medical School
Rebecca M. Reynolds, Edinburgh Medical School
Leanne M. Redman, Pennington Biomedical Research Center
Rodica Pop-Busui, University of Michigan Medical School
Toni I. Pollin, University of Maryland School of Medicine
Wei Perng, University of Colorado Anschutz Medical Campus

Document Type

Article

Publication Date

12-1-2023

Abstract

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.

This document is currently not available here.

Share

COinS