Technology in the management of type 2 diabetes: Present status and future prospects

Aideen Daly, Roman Hovorka, Aideen Daly, Roman Hovorka

Abstract

The growing incidence of type 2 diabetes (T2D) is a significant health concern, representing 90% of diabetes cases worldwide. As the disease progresses, resultant insulin deficiency and hyperglycaemia necessitates insulin therapy in many cases. It has been recognized that a significant number of people who have a clinical requirement for insulin therapy, as well as their healthcare professionals, are reluctant to intensify treatment with insulin due to fear of hypoglycaemia, poor understanding of treatment regimens or lack of engagement, and are therefore at higher risk of developing complications from poor glycaemic control. Over the past decade, the rise of diabetes technologies, including dosing advisors, continuous glucose monitoring systems, insulin pumps and automated insulin delivery systems, has led to great improvements in the therapies available, particularly to those requiring insulin. Although the focus has largely been on delivering these therapies to the type 1 diabetes population, it is becoming increasingly recognized that people with T2D face similar challenges to achieve recommended glycaemic standards and also have the potential to benefit from these advances. In this review, we discuss diabetes technologies that are currently available for people with T2D and the evidence supporting their use, as well as future prospects. We conclude that there is a clinical need to extend the use of these technologies to the T2D population to curb the consequences of suboptimal disease management in this group.

Keywords: CSII; continuous glucose monitoring (CGM); glycaemic control; insulin; pump therapy; systematic review; type 2 diabetes.

© 2021 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.

Figures

Figure 1. Clinical benefits of contemporary diabetes…
Figure 1. Clinical benefits of contemporary diabetes technologies
Venn diagram illustrating contemporary diabetes technologies and associated clinical benefits based on review of available literature.

References

    1. International Diabetes Federation. IDF Diabetes Atlas. 9th. Brussels, Belgium: 2019. Available at: .
    1. Khunti K, Wolden ML, Thorsted BL, Andersen M, Davies MJ. Clinical inertia in people with type 2 diabetes: a retrospective cohort study of more than 80,000 people. Diabetes Care. 2013 Nov;36(11):3411–7.
    1. Reach G, Pechtner V, Gentilella R, Corcos A, Ceriello A. Clinical inertia and its impact on treatment intensification in people with type 2 diabetes mellitus. Diabetes Metab. 2017 Dec;43(6):501–511.
    1. Cappon G, Vettoretti M, Sparacino G, Facchinetti A. Continuous Glucose Monitoring Sensors for Diabetes Management: A Review of Technologies and Applications. Diabetes Metab J. 2019;43(4):383–397.
    1. Dovc K, Battelino T. Evolution of Diabetes Technology. Endocrinol Metab Clin North Am. 2020;49(1):1–18.
    1. Leelarathna L, Choudhary P, Wilmot EG, et al. Hybrid closed-loop therapy: Where are we in 2021? Diabetes Obes Metab. 2020 Dec
    1. Ceriello A, deValk HW, Guerci B, et al. The burden of type 2 diabetes in Europe: Current and future aspects of insulin treatment from patient and healthcare spending perspectives. Diabetes Res Clin Pract. 2020 Mar;161:108053.
    1. National Institute for Health and Care Excellence (NICE) [Accessed 21st October 2020];NICE guideline (NG) 28 Type 2 diabetes in adults: management. Available from .
    1. Basu S, Yudkin JS, Kehlenbrink S, et al. Estimation of global insulin use for type 2 diabetes, 2018-30: a microsimulation analysis. Lancet Diabetes Endocrinol. 2019;7(1):25–33.
    1. Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002 Feb;346(6):393–403.
    1. Quinn CC, Clough SS, Minor JM, Lender D, Okafor MC, Gruber-Baldini A. WellDoc mobile diabetes management randomized controlled trial: change in clinical and behavioral outcomes and patient and physician satisfaction. Diabetes Technol Ther. 2008 Jun;10(3):160–8.
    1. Årsand E, Frøisland DH, Skrøvseth SO, et al. Mobile health applications to assist patients with diabetes: lessons learned and design implications. J Diabetes Sci Technol. 2012 Sep;6(5):1197–206.
    1. Arsand E, Tatara N, Østengen G, Hartvigsen G. Mobile phone-based self management tools for type 2 diabetes: the few touch application. J Diabetes Sci Technol. 2010 Mar;4(2):328–36.
    1. Whitehead L, Seaton P. The Effectiveness of Self-Management Mobile Phone and Tablet Apps in Long-term Condition Management: A Systematic Review. J Med Internet Res. 2016 May;18(5):e97.
    1. Frias J, Virdi N, Raja P, Kim Y, Savage G, Osterberg L. Effectiveness of Digital Medicines to Improve Clinical Outcomes in Patients with Uncontrolled Hypertension and Type 2 Diabetes: Prospective, Open-Label, Cluster-Randomized Pilot Clinical Trial. J Med Internet Res. 2017;19(7):e246.
    1. Kleinman NJ, Shah A, Shah S, Phatak S, Viswanathan V. Improved Medication Adherence and Frequency of Blood Glucose Self-Testing Using an m-Health Platform Versus Usual Care in a Multisite Randomized Clinical Trial Among People with Type 2 Diabetes in India. Telemed J E Health. 2017;23(9):733–740.
    1. Agarwal P, Mukerji G, Desveaux L, et al. Mobile App for Improved SelfManagement of Type 2 Diabetes: Multicenter Pragmatic Randomized Controlled Trial. JMIR Mhealth Uhealth. 2019;7(1):e10321.
    1. Torbjørnsen A, Ribu L, Rønnevig M, Grøttland A, Helseth S. Users’ acceptability of a mobile application for persons with type 2 diabetes: a qualitative study. BMC Health Serv Res. 2019 Sep;19(1):641.
    1. Hou C, Carter B, Hewitt J, Francisa T, Mayor S. Do Mobile Phone Applications Improve Glycemic Control (HbA1c) in the Self-management of Diabetes? A Systematic Review, Meta-analysis, and GRADE of 14 Randomized Trials. Diabetes Care. 2016 Nov;39(11):2089–2095.
    1. Lean ME, Leslie WS, Barnes AC, et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet. 2018;391(10120):541–551.
    1. National Institute for Health and Clinical Excellence (NICE) [Accessed 26 August 2020];NICE guideline (NG) 17, Type 1 diabetes in adults: diagnosis and management. Available from: .
    1. National Institute for Health and Clinical Excellence (NICE) [Accessed 7th September 2020];NICE guideline. Managing blood glucose in adults with type 2 diabetes. Available from .
    1. Davies MJ, D’Alessio DA, Fradkin J, et al. Management of hyperglycaemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) Diabetologia. 2018;61(12):2461–2498.
    1. Young LA, Buse JB, Weaver MA, et al. Glucose Self-monitoring in Non-Insulin-Treated Patients With Type 2 Diabetes in Primary Care Settings: A Randomized Trial. JAMA Intern Med. 2017;177(7):920–929.
    1. Nauck MA, Haastert B, Trautner C, Müller UA, Heinemann L. Diabetes-Gesellschaft) CTSGotGAftSoDD. A randomised, controlled trial of self-monitoring of blood glucose in patients with type 2 diabetes receiving conventional insulin treatment. Diabetologia. 2014 May;57(5):868–77.
    1. Machry RV, Rados DV, Gregório GR, Rodrigues TC. Self-monitoring blood glucose improves glycemic control in type 2 diabetes without intensive treatment: A systematic review and meta-analysis. Diabetes Res Clin Pract. 2018 Aug;142:173–187.
    1. Danne T, Nimri R, Battelino T, et al. International Consensus on Use of Continuous Glucose Monitoring. Diabetes Care. 2017;40(12):1631–1640.
    1. Hoss U, Budiman ES. Factory-Calibrated Continuous Glucose Sensors: The Science Behind the Technology. Diabetes Technol Ther. 2017;19(S2):S44–S50.
    1. Abbott Diabetes Care. [Accessed 28th October 2020];FreeStyle Libre Flash Glucose Monitoring System. Cited; Available from .
    1. Bailey T, Bode BW, Christiansen MP, Klaff LJ, Alva S. The Performance and Usability of a Factory-Calibrated Flash Glucose Monitoring System. Diabetes Technol Ther. 2015 Nov;17(11):787–94.
    1. Bolinder J, Antuna R, Geelhoed-Duijvestijn P, Kröger J, Weitgasser R. Novel glucose-sensing technology and hypoglycaemia in type 1 diabetes: a multicentre, nonmasked, randomised controlled trial. Lancet. 2016;388(10057):2254–2263.
    1. Edge J, Acerini C, Campbell F, et al. An alternative sensor-based method for glucose monitoring in children and young people with diabetes. Arch Dis Child. 2017 Jun;102(6):543–549.
    1. Yaron M, Roitman E, Aharon-Hananel G, et al. Effect of Flash Glucose Monitoring Technology on Glycemic Control and Treatment Satisfaction in Patients With Type 2 Diabetes. Diabetes Care. 2019;42(7):1178–1184.
    1. Castellana M, Parisi C, Di Molfetta S, et al. Efficacy and safety of flash glucose monitoring in patients with type 1 and type 2 diabetes: a systematic review and metaanalysis. BMJ Open Diabetes Res Care. 2020;8(1)
    1. Ajjan RA, Jackson N, Thomson SA. Reduction in HbA1c using professional flash glucose monitoring in insulin-treated type 2 diabetes patients managed in primary and secondary care settings: A pilot, multicentre, randomised controlled trial. Diab Vasc Dis Res. 2019;16(4):385–395.
    1. Haak T, Hanaire H, Ajjan R, Hermanns N, Riveline JP, Rayman G. Flash Glucose-Sensing Technology as a Replacement for Blood Glucose Monitoring for the Management of Insulin-Treated Type 2 Diabetes: a Multicenter, Open-Label Randomized Controlled Trial. Diabetes Ther. 2017 Feb;8(1):55–73.
    1. Furler J, O’Neal D, Speight J, et al. Use of professional-mode flash glucose monitoring, at 3-month intervals, in adults with type 2 diabetes in general practice (GP-OSMOTIC): a pragmatic, open-label, 12-month, randomised controlled trial. Lancet Diabetes Endocrinol. 2020;8(1):17–26.
    1. Heinemann L, Schoemaker M, Schmelzeisen-Redecker G, et al. Benefits and Limitations of MARD as a Performance Parameter for Continuous Glucose Monitoring in the Interstitial Space. J Diabetes Sci Technol. 2020;14(1):135–150.
    1. Kovatchev BP, Patek SD, Ortiz EA, Breton MD. Assessing sensor accuracy for nonadjunct use of continuous glucose monitoring. Diabetes Technol Ther. 2015 Mar;17(3):177–86.
    1. Sato T, Oshima H, Nakata K, et al. Accuracy of flash glucose monitoring in insulin-treated patients with type 2 diabetes. J Diabetes Investig. 2019 May;10(3):846–850.
    1. Hellmund R, Weitgasser R, Blissett D. Cost Calculation for a Flash Glucose Monitoring System for Adults with Type 2 Diabetes Mellitus Using Intensive Insulin -a UK Perspective. Eur Endocrinol. 2018 Sep;14(2):86–92.
    1. Abbott Newsroom. [Accessed 29th October 2020];FreeStyle Libre 3 Sets New Peak in Diabetes Care. Available from .
    1. National Institute for Health and Care Excellence (NICE) [Accessed 27th November 2020];FreeStyle Libre for glucose monitoring : Medtech innovation briefing [MIB110] 2017 Available from .
    1. American Diabetes Association. 7. Diabetes Technology: Diabetes Care. 2020 Jan;43(Suppl 1):S77–S88.
    1. Krhač M, Lovrenčić MV. Update on biomarkers of glycemic control. World J Diabetes. 2019 Jan;10(1):1–15.
    1. Vigersky RA, McMahon C. The Relationship of Hemoglobin A1C to Time-in-Range in Patients with Diabetes. Diabetes Technol Ther. 2019;21(2):81–85.
    1. Beck RW, Riddlesworth TD, Ruedy K, et al. Continuous Glucose Monitoring Versus Usual Care in Patients With Type 2 Diabetes Receiving Multiple Daily Insulin Injections: A Randomized Trial. Ann Intern Med. 2017 Sep;167(6):365–374.
    1. Acciaroli G, Vettoretti M, Facchinetti A, Sparacino G. Toward Calibration-Free Continuous Glucose Monitoring Sensors: Bayesian Calibration Approach Applied to Next Generation Dexcom Technology. Diabetes Technol Ther. 2018 Jan;20(1):59–67.
    1. Wadwa RP, Laffel LM, Shah VN, Garg SK. Accuracy of a Factory-Calibrated, Real Time Continuous Glucose Monitoring System During 10 Days of Use in Youth and Adults with Diabetes. Diabetes Technol Ther. 2018;20(6):395–402.
    1. Bailey KJ, Little JP, Jung ME. Self-Monitoring Using Continuous Glucose Monitors with Real-Time Feedback Improves Exercise Adherence in Individuals with Impaired Blood Glucose: A Pilot Study. Diabetes Technol Ther. 2016 Mar;18(3):185–93.
    1. Yoo HJ, An HG, Park SY, et al. Use of a real time continuous glucose monitoring system as a motivational device for poorly controlled type 2 diabetes. Diabetes Res Clin Pract. 2008 Oct;82(1):73–9.
    1. Sampath Kumar A, Maiya AG, Shastry BA, et al. Exercise and insulin resistance in type 2 diabetes mellitus: A systematic review and meta-analysis. Ann Phys Rehabil Med. 2019 Mar;62(2):98–103.
    1. Deiss D, Szadkowska A, Gordon D, et al. Clinical Practice Recommendations on the Routine Use of Eversense, the First Long-Term Implantable Continuous Glucose Monitoring System. Diabetes Technol Ther. 2019;21(5):254–264.
    1. Christiansen MP, Klaff LJ, Brazg R, et al. A Prospective Multicenter Evaluation of the Accuracy of a Novel Implanted Continuous Glucose Sensor: PRECISE II. Diabetes Technol Ther. 2018;20(3):197–206.
    1. Christiansen MP, Klaff LJ, Bailey TS, Brazg R, Carlson G, Tweden KS. A Prospective Multicenter Evaluation of the Accuracy and Safety of an Implanted Continuous Glucose Sensor: The PRECISION Study. Diabetes Technol Ther. 2019;21(5):231–237.
    1. Kropff J, Choudhary P, Neupane S, et al. Accuracy and Longevity of an Implantable Continuous Glucose Sensor in the PRECISE Study: A 180-Day, Prospective, Multicenter, Pivotal Trial. Diabetes Care. 2017 Jan;40(1):63–68.
    1. Petrie JR, Peters AL, Bergenstal RM, Holl RW, Fleming GA, Heinemann L. Improving the Clinical Value and Utility of CGM Systems: Issues and Recommendations: A Joint Statement of the European Association for the Study of Diabetes and the American Diabetes Association Diabetes Technology Working Group. Diabetes Care. 2017;40(12):1614–1621.
    1. National Institute for Health and Care Excellence (NICE) [Accessed 17th October 2020];NICE guideline NG17, NG18, NG19 and NG28. 2019 Available from .
    1. Klonoff DC, Kerr D. Smart Pens Will Improve Insulin Therapy. J Diabetes Sci Technol. 2018;12(3):551–553.
    1. Peyrot M, Barnett AH, Meneghini LF, Schumm-Draeger PM. Insulin adherence behaviours and barriers in the multinational Global Attitudes of Patients and Physicians in Insulin Therapy study. Diabet Med. 2012 May;29(5):682–9.
    1. Sangave NA, Aungst TD, Patel DK. Smart Connected Insulin Pens, Caps, and Attachments: A Review of the Future of Diabetes Technology. Diabetes Spectr. 2019 Nov;32(4):378–384.
    1. Diasend. [Accessed 10th November 2020];List of devices that can be uploaded via Glooko Transmitter. 2020 Available from .
    1. Gildon BW. InPen Smart Insulin Pen System: Product Review and User Experience. Diabetes Spectr. 2018 Nov;31(4):354–358.
    1. Munshi MN, Slyne C, Greenberg JM, et al. Nonadherence to Insulin Therapy Detected by Bluetooth-Enabled Pen Cap Is Associated With Poor Glycemic Control. Diabetes Care. 2019;42(6):1129–1131.
    1. Adolfsson P, Hartvig NV, Kaas A, Møller JB, Hellman J. Increased Time in Range and Fewer Missed Bolus Injections After Introduction of a Smart Connected Insulin Pen. Diabetes Technol Ther. 2020;22(10):709–718.
    1. Pickup JC, Reznik Y, Sutton AJ. Glycemic Control During Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Insulin Injections in Type 2 Diabetes: Individual Patient Data Meta-analysis and Meta-regression of Randomized Controlled Trials. Diabetes Care. 2017;40(5):715–722.
    1. National Institute for Health and Care Excellence (NICE) Technology appraisal guidance (TA151). Continuous subcutaneous insulin infusion for the treatment of diabetes mellitus. Available from: .
    1. American Diabetes Asociation. 7. Diabetes Technology: Diabetes Care. 2021 Jan;44(Suppl 1):S85–S99.
    1. Frias JP, Bode BW, Bailey TS, Kipnes MS, Brunelle R, Edelman SV. A 16-week open-label, multicenter pilot study assessing insulin pump therapy in patients with type 2 diabetes suboptimally controlled with multiple daily injections. J Diabetes Sci Technol. 2011 Jul;5(4):887–93.
    1. Gentry CK, Cross LB, Gross BN, McFarland MS, Bestermann WH. Retrospective analysis and patient satisfaction assessment of insulin pump therapy in patients with type 2 diabetes. South Med J. 2011 Jan;104(1):24–8.
    1. Reznik Y, Morera J, Rod A, et al. Efficacy of continuous subcutaneous insulin infusion in type 2 diabetes mellitus: a survey on a cohort of 102 patients with prolonged follow-up. Diabetes Technol Ther. 2010 Dec;12(12):931–6.
    1. Grunberger G, Bhargava A, Ly T, et al. Human regular U-500 insulin via continuous subcutaneous insulin infusion versus multiple daily injections in adults with type 2 diabetes: The VIVID study. Diabetes Obes Metab. 2020;22(3):434–441.
    1. Conget I, Castaneda J, Petrovski G, et al. The Impact of Insulin Pump Therapy on Glycemic Profiles in Patients with Type 2 Diabetes: Data from the OpT2mise Study. Diabetes Technol Ther. 2016 Jan;18(1):22–8.
    1. Chlup R, Runzis S, Castaneda J, Lee SW, Nguyen X, Cohen O. Complex Assessment of Metabolic Effectiveness of Insulin Pump Therapy in Patients with Type 2 Diabetes Beyond HbA1c Reduction. Diabetes Technol Ther. 2018;20(2):153–159.
    1. Reznik Y, Cohen O, Aronson R, et al. Insulin pump treatment compared with multiple daily injections for treatment of type 2 diabetes (OpT2mise): a randomised open-label controlled trial. Lancet. 2014 Oct;384(9950):1265–72.
    1. Edelman SV, Bode BW, Bailey TS, et al. Insulin pump therapy in patients with type 2 diabetes safely improved glycemic control using a simple insulin dosing regimen. Diabetes Technol Ther. 2010 Aug;12(8):627–33.
    1. Wolff-McDonagh P, Kaufmann J, Foreman S, Wisotsky S, Wisotsky JA, Wexler C. Using insulin pump therapy in poorly controlled type 2 diabetes. Diabetes Educ 2010. 2010 Jul-Aug;36(4):657–65.
    1. Harris S, Abrahamson MJ, Ceriello A, et al. Clinical Considerations When Initiating and Titrating Insulin Degludec/Liraglutide (IDegLira) in People with Type 2 Diabetes. Drugs. 2020 Feb;80(2):147–165.
    1. Zoungas S, Patel A, Chalmers J, et al. Severe hypoglycemia and risks of vascular events and death. N Engl J Med. 2010 Oct;363(15):1410–8.
    1. Goto A, Arah OA, Goto M, Terauchi Y, Noda M. Severe hypoglycaemia and cardiovascular disease: systematic review and meta-analysis with bias analysis. BMJ. 2013 Jul;347:f4533.
    1. Chamberlain JJ, Gilgen E. Do perceptions of insulin pump usability impact attitudes toward insulin pump therapy? A pilot study of individuals with type 1 and insulin-treated type 2 diabetes. J Diabetes Sci Technol. 2015 Jan;9(1):105–10.
    1. Stephens EA, Heffner J. Evaluating older patients with diabetes for insulin pump therapy. Diabetes Technol Ther. 2010 Jun;12(Suppl 1):S91-7.
    1. Schaeffer NE, Parks LJ, Verhoef ET, et al. Usability and training differences between two personal insulin pumps. J Diabetes Sci Technol. 2015 Mar;9(2):221–30.
    1. Reznik Y, Joubert M. The OPT2MISE Study -A Review of the Major Findings and Clinical Implications. Eur Endocrinol. 2015 Aug;11(2):70–74.
    1. Mora PF, Sutton DR, Gore A, et al. Efficacy, safety and cost-effectiveness comparison between U-100 human regular insulin and rapid acting insulin when delivered by V-Go wearable insulin delivery device in type 2 diabetes. BMJ Open Diabetes Res Care. 2020;8(2)
    1. Mader JK, Lilly LC, Aberer F, et al. Improved glycaemic control and treatment satisfaction with a simple wearable 3-day insulin delivery device among people with Type 2 diabetes. Diabet Med. 2018;35(10):1448–1456.
    1. Aronson R, Cohen O, Conget I, et al. OpT2mise: a randomized controlled trial to compare insulin pump therapy with multiple daily injections in the treatment of type 2 diabetes-research design and methods. Diabetes Technol Ther. 2014 Jul;16(7):414–20.
    1. Xu H, Verre MC. Type 2 Diabetes Mellitus in Children. Am Fam Physician. 2018;98(9):590–594.
    1. Roze S, Duteil E, Smith-Palmer J, et al. Cost-effectiveness of continuous subcutaneous insulin infusion in people with type 2 diabetes in the Netherlands. J Med Econ. 2016 Aug;19(8):742–9.
    1. David G, Gill M, Gunnarsson C, Shafiroff J, Edelman S. Switching from multiple daily injections to CSII pump therapy: insulin expenditures in type 2 diabetes. Am J Manag Care. 2014 Nov;20(11):e490-7.
    1. Wahlqvist P, Warner J, Morlock R. Cost-effectiveness of Simple Insulin Infusion Devices Compared to Multiple Daily Injections in Uncontrolled Type 2 Diabetics in the United States Based on a Simulation Model. J Health Econ Outcomes Res. 2018;6(1):84–95.
    1. Lynch PM, Riedel AA, Samant N, et al. Resource utilization with insulin pump therapy for type 2 diabetes mellitus. Am J Manag Care. 2010;16(12):892–6.
    1. Rodbard D. Continuous Glucose Monitoring: A Review of Recent Studies Demonstrating Improved Glycemic Outcomes. Diabetes Technol Ther. 2017;19(S3):S25–S37.
    1. Chen E, King F, Kohn MA, Spanakis EK, Breton M, Klonoff DC. A Review of Predictive Low Glucose Suspend and Its Effectiveness in Preventing Nocturnal Hypoglycemia. Diabetes Technol Ther. 2019;21(10):602–609.
    1. Bergenstal RM, Klonoff DC, Garg SK, et al. Threshold-based insulin-pump interruption for reduction of hypoglycemia. N Engl J Med. 2013 Jul;369(3):224–32.
    1. Minimed 670G: a hybrid closed-loop insulin delivery system. Med Lett Drugs Ther. 2016 Nov;58(1508):147–148.
    1. Bally L, Thabit H, Hartnell S, et al. Closed-Loop Insulin Delivery for Glycemic Control in Noncritical Care. N Engl J Med. 2018 Aug;379(6):547–556.
    1. Bally L, Gubler P, Thabit H, et al. Fully closed-loop insulin delivery improves glucose control of inpatients with type 2 diabetes receiving hemodialysis. Kidney Int. 2019;96(3):593–596.
    1. Thabit H, Hartnell S, Allen JM, et al. Closed-loop insulin delivery in inpatients with type 2 diabetes: a randomised, parallel-group trial. Lancet Diabetes Endocrinol. 2017;5(2):117–124.
    1. Kumareswaran K, Thabit H, Leelarathna L, et al. Feasibility of closed-loop insulin delivery in type 2 diabetes: a randomized controlled study. Diabetes Care. 2014;37(5):1198–203.
    1. Boughton CK, Bally L, Martignoni F, et al. Fully closed-loop insulin delivery in inpatients receiving nutritional support: a two-centre, open-label, randomised controlled trial. Lancet Diabetes Endocrinol. 2019;7(5):368–377.
    1. Li A, Hussain S. Diabetes technologies -what the general physician needs to know. Clin Med (Lond) 2020;20(5):469–476.
    1. Marso SP, Daniels GH, Brown-Frandsen K, et al. Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes. N Engl JMed. 2016;375(4):311–22.
    1. Emperra Digital Diabetes Care. [Accessed 16th November 2020];ESYSTA Personal and fully automatic. 2017 Available from .
    1. Pendiq Intelligent Diabetes Care. [Accessed 20th November 2020];PENDIQ 2.0. 2017 Available from
    1. YDS Delivery Systems. [Accessed 19th November 2020];SmartPilot-Transforming YpsoMate into a smart product system. 2020 Available from .

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel