Advances in Diabetes Technology (Contemporary Endocrinology)

Foreword
	References
Contents
Chapter 1: Introduction
	References
Chapter 2: Overview of Currently Available Insulin Delivery Systems
	Insulin Delivery Via Subcutaneous Route
		Vial and Syringe
		Insulin Pens
		Injection Port
		Continuous Subcutaneous Insulin Infusion
		Sensor-Augmented Pump Therapy
		Continuous Glucose Monitoring
		Do-It-Yourself Artificial Pancreas Systems
		Closed-Loop Systems
		Alternate Controller-Enabled Infusion (ACE) Pumps
		Insulin Pumps Designed for DM2
		Bionic Pancreas
		Jet Injectors
	Insulin Delivery Via Intraperitoneal Route
	Insulin Delivery Via Pulmonary Route
	Insulin Delivery Via Oral Route
		Absorption Enhancers
		Enzyme Inhibitors
		Chemical Modification
		Carrier Molecules
	Insulin Delivery Via Buccal Route
	Insulin Delivery Via Transplantation
	Conclusion
	References
Chapter 3: Understanding Continuous Glucose Monitoring
	Introduction
	Types of CGM Devices
		FreeStyle Libre
		Dexcom [9]
		Medtronic [10]
		Eversense [11]
	Randomized Controlled Trials Evaluating Continuous Glucose Monitoring
		Type 1 Diabetes
		Type 2 Diabetes
		Intermittently Scanned Continuous Glucose Monitoring (isCGM)
		Youth Population
		Conclusion
	Accuracy of CGMs Relative to Blood Glucose Measurements
		Mean Absolute Relative Difference (MARD) [14, 15]
		Clarke Error Grid Analysis
		Percentage of Readings within Specific Ranges
		Discussion
	Drawbacks to CGM Use
	Assessment of Glycemic Control
		Time in Range (TIR) and Glycemic Control
		CGMs vs. POCT in Inpatient Settings
		Benefits for Specific Populations
		Limitations of POCT in Critical Care
		Regulatory Changes and Integration Challenges
		Core Data Set for EHR Documentation
	Clinical Contraindications for the Use of CGMS
		Medical Imaging and Procedures
		Procedures Requiring CGM Removal
		Evidence Supporting the Outpatient Use of CGMs
	Using CGM in the Inpatient Setting
		Clinical Professional Staff Instructions for CGM Use in Hospitalized Patients
	Analysis of CGM in the Inpatient Setting
		Summary
		Use of CGM Devices During Surgical Procedures
		Use of CGM Devices in Pregnancy
		Case Report: CGM Use in a Critically Ill Inpatient
	Conclusions on CGM Usage in the Inpatient Setting
	Conclusion
	References
Chapter 4: Basic Principles of Automated Insulin Delivery Systems
	Insulin Pump Therapy in Clinical Practice
	Insulin to Carbohydrate Ratio (ICR)
	Manual Alteration in Basal Rates
		Insulin Duration of Action (Becomes the Insulin Onboard)
	Hybrid, Closed-Loop, and Automated Insulin Delivery Systems
		Medtronic 770G and Beyond
		Ominipod 5system Powered by Horizon™
		t:slim X2 Basal and Control IQ Systems by Tandem
	Do-It-Yourself (DIY) and Super Loopers
		Bionic Pancreas (BP)
	Life Circumstances Such as Exercise, Sleep, and Illness
		Exercise or Activity Function
		Sleep Mode
		Periods of Illness
	Essential for Success with IDD/CGM Systems
	Looking Forward to the Future
	References
Chapter 5: Continuous Insulin Delivery Systems in the Management of Diabetes Mellitus
	Introduction
	Current Insulin Pump Technology
	Insulins, Insulin Analogues, and Biosimilars in Insulin Pump Therapy
	Insulin Pump Supplies and Costs
	The Importance of a Back-Up Plan (“Plan B”) in Insulin Pump Therapy
	The Future of Insulin Pump Therapy
	References
		Further Reading
Chapter 6: Algorithmic Automated Insulin Dosing
	Advancements in Technology and the Development of Automated Insulin Delivery Systems
	Algorithms and Hybrid Closed Loop Systems
		PID Control Algorithms
		Model Predictive Control Algorithms
		Fuzzy Logic Control (FLC)
	Currently Available HCL Systems in United States
		Medtronic 670g/770g
		The Medtronic 670g/770g System Operates in Three Modes: Automode, Manual Mode, and Safe Basal
		T:slim X2 Control IQ
		Model Predictive Control and the Omnipod 5
	The CARES Framework
	Benefits of Automated Insulin Delivery Systems
	Challenges and Limitation of Automated Insulin Delivery Systems
	Candidate Selection for HCL
	Do-It Yourself Closed Loop Systems
	Ensuring Realistic Expectations
	Dual Hormone Closed Loop Systems
	Fully Closed Loop Systems
	References
Chapter 7: Diabetes Technology in the Geriatric Population
	Physiological Changes
	Cognitive Decline
	Hypoglycemia
		Safety of Intensive Glucose Control
	Polypharmacy
	Visual and Hearing Impairment
	mHealth
		mHealth Apps
		Telemedicine
		Benefits of mHealth in Older Adults
		Barriers to mHealth in Older Adults
	Continuous Glucose Monitors
		Literature on CGM Use in Older Adults
		Benefits of CGM Use in Older Adults
		Patient-Reported Outcomes with CGM Use in Older Adults
		Barriers to CGM Use in Older Adults
	Smart Insulin Pens and Pen Caps
		Literature on SIPs and Pen Cap Use in Older Adults
		Benefits of SIPs and Pen Cap Use in Older Adults
		Barriers to SIPs and Pen Cap Use in Older Adults
	Insulin Delivery Systems
		Insulin Pumps
			Benefit of Insulin Pumps in Older Adults
				Improved Clinical Outcomes
				Patient-Related Outcomes
			Benefit of Insulin Pumps in Older Adults
				Cost-Related Barriers
				Patient-Related Barriers
				Other Pump-Related Concerns
		Glucagon
		Gvoke Xeris Pharmaceuticals
		Baqsimi
			Benefits and Barriers of New Formulations of Glucagon in Older Adults
	Conclusion
	References
Chapter 8: Diabetes Do-It-Yourself (DIY) Technology
	Origins of OpenAPS
	Availability to Public
	Evolution of DIY Technology
		Nightscout
		OpenAPS
		LoopDocs
		AAPS
		Tide Pool
	Current State of DIY Technology
		Factors Supporting DIY Technology
		Factors Against DIY Technology
	Research on DIY Technology
	Conclusion
	References
Chapter 9: A Historic FDA Clearance: Open Source Software and the Making of Tidepool Loop
	Introduction
	Open Source Software
	The Problem with Proprietary Software
	Open Source Branches
		Branch-Tidepool
		Branch-DIY-Loop
		Tidepool Loop
	Open Source for Public Health
		“It’s Not Impossible”
	References
Index