ESPE Abstracts

Type 1 diabetes is one of the most challenging long-term conditions to manage. On an average day the person with diabetes is expected to check their glucose multiple times, plan their dietary intake so that they are able to administer the calculated dose of insulin, via an insulin pump or injection, 15 minutes before the meal. They need to constantly strive for optimal glucose levels but the inherent variability in insulin requirements means that this often results in debilitating iatrogenic hypoglycaemia. The burden on the individual and/or their carers is substantial. Diabetes technology, in the form of closed loop systems, provide a potential solution to both improve clinical outcomes and simultaneously alleviate some of the burden of living with diabetes. In a closed loop system the continuous glucose monitor communicates with the insulin pump to automate insulin delivery in a gluco-responsive manner. This lecture will explore the commercially available closed loop systems and the published randomised controlled trial data supporting their use. Across the published studies, closed loop systems have been associated with improvements in time in range, time below range and HbA1c. Furthermore, qualitative work has provided insight into the psychosocial benefits associated with use of the systems. Despite these demonstrated benefits, a range of barriers to the uptake of closed loop systems exist. This lecture will explore these and suggest how we tackle each in turn. Finally, consideration will be given to the large number of people who, unable to access funded commercial closed loop systems, have opted to build their own do-it-yourself closed loop system. Despite reassuring outcomes in terms of glycaemic control, the use of these do-it-yourself systems present an ethical and medicolegal conundrum for healthcare professionals. The outcomes of the Diabetes Technology Network UK healthcare professional opinions of do-it-yourself closed loop systems will be shared.