Abstract
In the past century, since the discovery of insulin, methods of insulin delivery and
glucose monitoring have advanced technologically. In particular, the introduction
of insulin pumps, providing continuous subcutaneous insulin infusion (CSII), and continuous
glucose monitors (CGMs) have been revolutionary for people living with type 1 diabetes.
In this review, we have focussed on automated insulin delivery (AID) systems and discuss
the implications of both approved and off-label options for the user and health-care
providers. By pairing insulin pumps with CGM, AID systems facilitate automated adjustment
in insulin delivery based on CGM readings. A subset of these have been developed commercially
and were granted regulatory approval. In contrast, unregulated do-it-yourself AID
systems, designed and set up by people living with type 1 diabetes and their families,
have advanced rapidly and are gaining popularity worldwide. These patient-driven technologies
have demonstrated impressive user self-reported improvements in glycemic control and
quality of life, but have not been evaluated in any formal randomized controlled trials
or by regulators. This presents challenging uncertainty for health-care providers,
in addition to ethical and legal implications in supporting people with diabetes who
wish to use these technologies. The current knowledge, opinions and practices relating
to the use of AID systems across Canada are unknown. Gathering this information will
highlight current practice and areas of knowledge gaps and concern and will assist
in focussed education. This understanding is crucial to ensure people with type 1
diabetes using these systems have access to optimal, consistent and safe patient-centred
care.
Résumé
Depuis la découverte de l’insuline au cours du siècle dernier, les méthodes d’administration
de l’insuline et la surveillance de la glycémie ont connu des avancées technologiques.
Particulièrement, l’introduction des pompes à insuline, qui offrent une perfusion
sous-cutanée continue d’insuline (PSCI), et des moniteurs de glucose en continu (MGC)
a révolutionné le traitement des personnes qui vivent avec le diabète de type 1. Dans
la présente revue, nous nous sommes penchés sur les systèmes d’administration automatisée
de l’insuline (AAI) et avons discuté des répercussions des deux options, homologuées
et non conformes, sur les utilisateurs et les prestataires de soins de santé. En jumelant
les pompes à insuline aux MGC, les systèmes d’AAI facilitent l’ajustement automatique
de l’administration de l’insuline grâce aux lectures du MGC. Une sous-catégorie de
ceux-ci a été mise au point commercialement et s’est vu accorder une approbation réglementaire.
En revanche, les systèmes d’AAI non réglementés à faire soi-même, conçus et configurés
par les personnes qui vivent avec le diabète de type 1 et leur famille, ont évolué
rapidement et retiennent de plus en plus l’attention dans le monde entier. Ces technologies
axées sur le patient ont démontré selon les utilisateurs des améliorations impressionnantes
de la régulation de la glycémie et de la qualité de vie, mais n’ont pas été évaluées
au cours d’aucun essai clinique à répartition aléatoire formel ou par les organismes
de réglementation. Cela crée une grande incertitude chez les prestataires de soins
de santé, outre les incidences éthiques et juridiques, pour aider les personnes diabétiques
qui souhaitent utiliser ces technologies. Les connaissances, les opinions et les pratiques
actuelles en matière d’utilisation des systèmes d’AAI au Canada sont méconnues. Le
recueil de ces informations permettra de mettre en lumière la pratique actuelle et
les lacunes et les préoccupations en matière de connaissances, et d’offrir une éducation
spécifique. Cette compréhension est cruciale pour faire en sorte que les personnes
diabétiques de type 1 qui utilisent ces systèmes aient accès à des soins axés sur
le patient, optimaux, constants et sécuritaires.
Keywords
Mots clés
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Article info
Publication history
Published online: June 21, 2022
Accepted:
June 13,
2022
Received in revised form:
May 27,
2022
Received:
January 28,
2022
Identification
Copyright
© 2022 Canadian Diabetes Association.
