The Artificial Pancreas
|
|
- Bertram Wells
- 6 years ago
- Views:
Transcription
1 SAGLB.DIA (2). Approved October 215 The Artificial Pancreas For scientific and medical purposes only
2 The pancreas responds to changes in blood glucose by releasing insulin (β cells) to lower blood glucose or glucagon ( cells) to increase blood glucose Euglycemia requires cross talk between multiple signalling pathways 1 Glucose output by liver Glucose-mediated insulin secretion 5. mmol/l (9 mg/dl) Glucose targets the liver Glycogen Insulin targets tissues Increased glucose uptake by tissues 3.9 mmol/l (7 mg/dl) Increased glucose uptake by liver (stored as glycogen) Glucose-mediated glucagon secretion Insulinotropic function Glucagonotropic function 1. Adapted from Herman MA, Kahn BB. J Clin Invest 26;116: Georg Thieme Verlag KG
3 Plasma glucose concentration (mg/1 ml) The feasibility of automated control of blood glucose was demonstrated by several groups in the 197s 2 Plasma glucose responses to the OGTT in 7 healthy persons (±SD) 1 2 Plasma glucose responses to the OGTT in a T1DM patient controlled by a prototype artificial pancreas 1 1 g glucose orally Patient: blood sugar Time (minutes) Time (minutes) Early systems in animal 2 and human 1 experiments relied on IV administration of glucose and insulin; carefully supervised inpatient conditions were required OGTT, oral glucose tolerance test T1DM, type 1 diabetes 1. Kerner W, et al. Horm Metab Res 1976;8: Georg Thieme Verlag KG 2. Albisser AM, et al. Diabetes 1974;23:389 96
4 The open-loop model of glucose control 1 External input External output CGM Insulin infusion CGM, continuous glucose monitoring Glucose metabolism 1. Adapted from Guidance/GuidanceDocuments/UCM25935.pdf [Accessed 21 October 215]
5 In an artificial pancreas, a control algorithm closes the loop between CGM data and insulin pump delivery 1 Internal control CGM Insulin infusion Glucose metabolism 1. Adapted from Guidance/GuidanceDocuments/UCM25935.pdf [Accessed 21 October 215]
6 Components of a closed-loop system: Algorithms
7 Infused insulin Control algorithms: Proportional-integral-derivative (PID) mimics the beta cell response to glucose Hyperglycemic clamp model glucose step up Rate of change component [D(n)] adjusts insulin infusion rate in response to change in measured glucose level Incremental component [I(n)] increases insulin infusion rate in proportion to difference between target and measured glucose levels Proportional component [P(n)] maintains insulin infusion rate in proportion to difference between target and measured glucose levels D(n) I (n) P (n) Time The three components of PID regulate insulin infusion in response to measured glucose levels; the different elements reflect basal and prandial insulin secretion 1 1. Steil GM, et al. Diabetes 26;55: American Diabetes Association [Diabetes], American Diabetes Association, [26]. Copyright and all rights reserved. Material from this publication has been used with the permission of American Diabetes Association
8 Infused insulin Glucose level Control algorithms: Model predictive control (MPC) calculates future glucose levels and responds accordingly Past Present Future Measured Predicted Target Prediction horizon Predicted Measured Time Control horizon The rate and extent of insulin infusion is regulated by modelled prediction of future glucose levels; the model is reset at each new measurement using a defined horizon 1 1. Bequette BW. J Diabetes Sci Technol 213;7: Reprinted from J Diabetes Sci Technol, Vol 7, Bequette BW, Comparison of dual-hormone artificial pancreas, singlehormone artificial pancreas, and conventional insulin pump therapy for glycaemic control in patients with type 1 diabetes: an open-label randomised controlled crossover trial, , Copyright (213), with permission from Elsevier
9 Control algorithms: Fuzzy logic accounts for individual patient treatment approaches Current and prior glucose levels: Rate of change in glucose level Direction of change in glucose level Duration of change in glucose level Change in insulin dosing (1) Pre-processing step Prediction of future glucose levels (3) Control to Target module Conversion of % change to units or units/hr Modelling of target and insulin dynamics/safety (2) Control to Range module Range: 8 12 mg/dl Input: Future/Past glucose levels and trends Glucose parameters: very low to very high Output: % change in basal rate and bolus portion, based on glucose parameters Output decisions defined by fuzzy logic (between and 1) Fuzzy logic rules incorporate HCP decision making and are non-binary, i.e. not Yes versus no, but How much? 1 HCP, health care professional 1. Adapted from Atlas E, et al. Diabetes Care 21;33:172 6
10 Control algorithms: BiAP employs a complex mathematical model of beta cell physiology INPUTS CONTROLLER SAFETY CHO & I:CHO Bolus calculator 7% s.c. sensor glucose Reinternalization r Priming RRP Forecast s.c. sensor glucose Forecast Mobilization and docking Docked pool β-cell model p p Fusion f Release Fused pool (F) Kiss & run k m SR = mf K L.G.S. Basal insulin profile 7% Insulin feedback CHO, carbohydrate; I:CHO, insulin:carbohydrate; RRP, readily releasable pool; SR, secretion rate; K, tuning gain; L.G.S., low glucose suspend; s.c., subcutaneous The use of a non-minimal/complex model of insulin secretion allows for a more accurate representation of the bi-phasic nature of insulin secretion 1 BiAP, bio-inspired artificial pancreas 1. Reddy M, et al. Diabetes Technol Ther 214;16:55 7 Georg Thieme Verlag KG
11 Components of a closed-loop system: Pumps
12 Pumps Pumps vary according to manufacturer Animas, OmniPod, Medtronic, Roche, Tandem Insulin is stored in a reservoir and delivered subcutaneously via an infusion set 1 The pump is programmed manually by the patient, based on CGM or SMBG readings Sensor-augmented pumps can communicate wirelessly with CGM sensor, to stop insulin supply at threshold glucose levels 2 SMBG, self monitoring of blood glucose 1. Valla V, Exp Diabetes Res 21: Tauschmann M, et al. Expert Opin Drug Deliv 214;11:943 55
13 Survival of infusion set Infusion sets Major cause of pump failure Failure rates similar between Teflon and steel needle catheters in a randomized crossover study of 2 patients 1 Typical failures include: 1,2 Kinking (Teflon only) Failed correction dose Pain, itching, infection, induration Accidental removal Loss of adhesion Priming errors Blockages ST, Sure-T steel catheter QS, Quick-Set Teflon catheter Survival curve for all causes of infusion set failure 1 ST QS Time (days) 1. Patel PJ, et al. Diabetes Technol Ther 214;16:15 9 The publisher for this copyrighted material is Mary Ann Liebert, Inc. publishers 2. Tauschmann M, et al. Expert Opin Drug Deliv 214;11:943 55
14 The sensor augmented pump has been an important step in the development of the artificial pancreas 247 patients received sensor-augmented insulin-pump therapy ± threshold-suspend feature for 3 months Mean AUC for nocturnal hypoglycemic events 1 Mean AUC for nocturnal hypoglycemic events (mg/dl x min) Percentage reduction (%) p value Threshold-suspend group (N=121) Control group (N=126) Run-in phase 1547 ± ± 195 Study phase 98 ± ± p<.1 Sensor glucose <7 mg/dl 1 Threshold-suspend group (N=121) Nocturnal Control group (N=126) Day and night combined Threshold-suspend group (N=121) Control group (N=126) 6 to <7 mg/dl (%) to <6 mg/dl (%) <5 mg/dl (%) Threshold suspension lowers the occurrence of nocturnal hypoglycemia without affecting glycemic control AUC, area under curve 1. Bergenstal RM, et al. N Engl J Med 213;369:224 32
15 Components of a closed-loop system: CGM
16 MARD % (SD) Development of the artificial pancreas requires CGM systems that approach the clinical performance of SMBG systems CGMs measure glucose in interstitial fluid Less accurate than SMBG Concerns with accuracy at hypoglycemic levels (BG <4. mmol/l) Dexcom G4 p<.1 13,87 17,85 2,4 34,69 All data Enlite p=.41 Glucose <4. mmol/l 1 1 New 55 software improves the accuracy of the Dexcom G4: Overall MARD (9% vs 13%), accuracy at low BG levels, and accuracy over time 2 1. Adapted from Matuleviciene V. Diabetes Technol Ther 214;16: BG, blood glucose 2. MARD, mean absolute relative difference CGM to SMBG [Accessed 16 March 215]
17 Non-invasive CGM (NGM) systems NGM obviates the need for a strip this makes the repeated measurements highly cost-effective, but lacks the precision and specificity of BG meters 1 Two NGM systems in development: HG1-c (raman spectroscopy) 2 Comparable precision with BG meters Smartphone compatible Cost-effective compared with fingerstick testing Available in the US for investigational use only GlucoTrack TM (ultrasonic, electromagnetic, heat capacity) 3 High precision Improvements in calibration/algorithms required Not yet available Currently no data to support the use of non-invasive CGM in a closed-loop system 1. Vashist SK. Diagnostics 213;3: Keenan DB. J Diabetes Sci Technol 21,4: Harman-Boehm I. J Diabetes Sci Technol 29;3:253 6
18 CGM systems are approaching the clinical performance of SMBG systems CGM accuracy should not limit the development of an artificial pancreas Systems such as Dexcom G4 have improved accuracy in the hypoglycemic range Comparing CGM with YSI in a study of 51 patients found: Mean absolute relative difference: 9.% Average differences improved with duration of wear (1.7%, 8.% and 8.5% on Days 1, 4 and 7, respectively) Clinical accuracy was 92.9% for both hypoglycemia and hyperglycemia Pearson correlation coefficient between CGM and YSI was.97 (p<.1) When comparing CGM with SMBG the results were similar Mean absolute relative difference: 11.2% Average differences improved with duration of wear (12.7%, 1.9% and 9.9% on Days 1, 4 and 7, respectively) Clinical accuracy was 85.4% for both hypoglycemia and hyperglycemia YSI, Yellow Springs Instrument Bailey TS, et al. J Diabetes Sci Technol 215;9:29 14
19 Developments in closed-loop systems for the outpatient setting
20 Percentage (%) mg/dl Percentage (%) The Florence closed-loop system is reliable, safe and effective in maintaining glucose levels in a real-life setting Early start closed-loop delivery (n=8) Study outcomes 1 Hypoglycemia 1 Late start closed-loop delivery (n=8) Hyperglycemia p=.36 p= p= p= p= * * * p= * * p=1. The Florence system utilizes a MPC algorithm and was evaluated in 16 adolescents with T1DM at a clinical research facility Low blood glucose index was greater in the early closed-loop cohort vs. the late closed group cohort (.9 vs..3, respectively; P=.28) 1. Elleri D, et al. Pediatr Diabetes 212;13:449 53
21 Real-time remote monitoring is an important consideration in artificial pancreas development: The DiAs approach 1 DiAs smart phone: 1 CGM and insulin delivery traces are shown. Traffic lights representing hyper- and hypoglycemia risk are also shown 2 The artificial pancreas sends data in real time to a remote server. 2 Data are stored and can be monitored remotely 3 Multiple patient monitoring screen: 2 Here, two patients are monitored at one time. The system alerts that one patient is at risk for hypoglycemia DiAs, Diabetes Assistant 1. Kovatchev BP, et al. Diabetes Care 213;36: Place J, et al. J Diabetes Sci Technol 213;7:
22 Unihormonal closed-loop control in an outpatient setting
23 The patient-operated, closed-loop DiAs system reduced hypoglycemia compared with open-loop pump therapy in a supervised outpatient setting 1 2 patient crossover trial No significant difference (p >.1) between the open-loop and closed-loop cohorts for secondary endpoints percent of time in the target range of mmol/l [7 18 mg/dl] percent of time >18 mg/dl glucose variability total mean carbohydrate content/person/session total insulin delivered/person/session 3 2,5 2 1,5 1,5 Primary endpoints in 2 patients 45 Open-loop p=.21 4 Closed-loop p>.1 p= p= except average blood glucose 8.45 vs 9.96 mmol/l [p=.42] 1. Kovatchev BP, et al. Diabetes Care 214;37:
24 The patient-operated, closed-loop DiAs system reduced hypoglycemia compared with open-loop pump therapy in a supervised outpatient setting 1 2 patient crossover trial No significant difference (p >.1) between the open-loop and closed-loop cohorts for secondary endpoints percent of time in the target range of mmol/l [7 18 mg/dl] percent of time >18 mg/dl glucose variability total mean carbohydrate content/person/session total insulin delivered/person/session Primary endpoints in 2 patients Open-loop Closed-loop p=.3 P> p= p= except average blood glucose 8.45 vs 9.96 mmol/l [p=.42] 1. Kovatchev BP, et al. Diabetes Care 214;37: ; American Diabetes Association [Diabetes Care], American Diabetes Association, [214]. Copyright and all rights reserved. Material from this publication has been used with the permission of American Diabetes Association
25 The patient-operated, closed-loop DiAs system reduced hypoglycemia compared with open-loop pump therapy in a supervised outpatient setting 1 2 patient crossover trial No significant difference (p >.1) between the open-loop and closed-loop cohorts for secondary endpoints percent of time in the target range of mmol/l [7 18 mg/dl] percent of time >18 mg/dl glucose variability total mean carbohydrate content/person/session total insulin delivered/person/session Primary endpoints in 2 patients Open-loop Closed-loop p=.3 P> p= p= except average blood glucose 8.45 vs 9.96 mmol/l [p=.42] 1. Kovatchev BP, et al. Diabetes Care 214;37:
26 Percentage of time The DiAs system improved glycemic control and reduced nocturnal hypoglycemia compared with open-loop pump therapy during the course of a diabetes camp 1 2 patient crossover trial More time in the target glucose range *p<.5 * Per protocol closed-loop (nights, n=41) Sensor-augmented pump (nights, n=39) Less time in hypoglycemic range * * * <5 <6 < Glucose range (mg/dl) 1. Ly TT, et al. Diabetes Care 214;37:231 6
27 mg/dl The MD-Logic artificial pancreas is controlled by a fuzzy logic algorithm and has demonstrated tighter glucose control with less nocturnal hypoglycemia vs open-loop at a diabetes camp 1 Primary endpoints in 54 patients 56 patient single night crossover trial 25 Artificial pancreas Control 18 Artificial pancreas Control Glucose levels were significantly more stable More hypoglycemia AEs were reported in the control group vs. the artificial pancreas group (28 vs. 19 [daytime], and 19 vs. 6 [nighttime]) Total number of overnight episodes of glucose levels <63 mg/dl ,4 14,4 Overnight glucose level Bars indicate IQR 1. Phillip M, et al. N Engl J Med 213;368:824 33
28 Percentage (%) Percentage (%) Long-term home use of the MD-Logic system was found to be effective in reducing nocturnal hypoglycemia and in improving overnight glycemic control 1 24 patient crossover trial of MD-Logic system vs sensor-augmented pump Significantly reduced overnight hypoglycemia Increased time in target glucose range Paired difference for the primary endpoint in the ITT population, median % (IQR) p= Paired difference for the secondary endpoints in the ITT population, median % (IQR) p= p= p= Time glucose level spent <7 mg/dl -15 ITT, intent to treat; Paired difference is closed loop minus control 1. Nimri R, et al. Diabetes Care 214;37:325 32
29 Time in target (%) Mean glucose overnight (mmoi/l) Unsupervised overnight closed-loop insulin delivery at home can be more effective at improving glucose control than open-loop 1 25 patient crossover trial 8 12 Overnight closed-loop therapy controlled by a MPC algorithm vs open-loop therapy Time in target glucose range was significantly higher with closed-loop therapy Control Closed loop Individual values of time when glucose was in target glucose range of mmol/l Control Closed loop Individual values of mean overnight glucose 1. Thabit H, et al. Lancet Diabetes Endocrinol 214;2:71 9; Reprinted from Lancet Diabetes Endocrinol, Vol.2, Thabit H, et al., Pages.71 9, Copyright (214), with permission from Elsevier.
30 Bihormonal closed-loop control
31 Glucose (mg/dl) Insulin (U/hr) and glucagon (µg/min) delivery rates Glucose (mg/dl) Insulin delivery rate (U/hr) Glucagon given by algorithm during impending hypoglycemia is effective in preventing most cases of hypoglycemia 1 14 patient trial Closed-loop insulin + placebo vs insulin + glucagon (bihormonal) Glucagon was delivered rapidly (high-gain) or slowly (low-gain) High-gain glucagon reduced hypoglycemic events and need for carbohydrate treatment Summary of glucose levels (means ± SE), insulin delivery rate, and for glucagon studies, the glucagon delivery rate Blood glucose Meals Insulin delivery rate Study time (minutes) Blood glucose Meals Insulin delivery rate Glucagon delivery rate Glucose Glucose Study time (minutes) 1. Castle JR, et al. Diabetes Care 21;33:1282 7; American Diabetes Association [Diabetes Care] American Diabetes Association, [21]. Copyright and all rights reserved. Material from this publication has been used with the permission of American Diabetes Association
32 Mean glucose levels (mg/dl) The bionic pancreas improved glycemic control with fewer hypoglycemic episodes compared with an insulin pump 1 Mean glucose levels in adults and adolescents 2 adults and 32 adolescents participated in testing 2 18 p<.1 p=.4 Bionic pancreas Control Automated, bihormonal, bionic pancreas consisting of: iphone G4 Platinum GCM t:slim infusion pumps Reductions in mean glucose level and hypoglycemia occurred vs control (own existing insulin pump) Adults Adolescents 1. Russell SJ, et al. N Engl J Med 214;371:313 25
33 Bihormonal control additional considerations: Glucagon is unstable Glucagon cannot be kept in a portable pump long-term 1 A comparison of approaches showed that the unihormonal AP may be sufficient for overnight control 1 Conventional insulin pump therapy (n=29) p value* Singlehormone artificial pancreas (n=3) Patients with at least one hypoglycemic event p value Dualhormone artificial pancreas (n=29) p value During whole study 24 (83%) <.1 5 (17%).73 6 (21%).14 period Overnight 1 (34%).4 (%).. (%).4 Exerciseinduced 11 (38%).4 2 (7%).38 4 (14%).15 Number of hypoglycemic events Total Overnight Exerciseinduced Number of half-hourly overnight plasma glucose measurements, mmol/l (%) <4. 7 (12.7).. 25 (4.).. 11 (2.).. < (6.).. 9 (1.6).. 2 (.4).. < (4.).. 6 (1.1).. 1 (.2).. *Conventional vs single; Single vs dual; Dual vs conventional Reprinted from Lancet Diabetes Endocrinol, Vol 3, Haidar A, et al. Pages 17 26, Copyright (215), with permission from Elsevier.
34 Units/day Bihormonal control additional considerations: continuous infusion of insulin and amylin proved effective in reducing HbA1c and weight in patients with T1DM and T2DM 1 1 patients switched from insulin to insulin + amylin (SYMLIN) Total daily insulin Start of therapy End of therapy Treatment continued for up to 5 years Average reduction in HbA1c from 8.3% to 6.9% Decrease in average weight from lb to lb Total daily insulin decreased as amylin doses were increased Insulin SYMLIN Amylin conversion of units to g: 1 unit = 6 g 1. Schorr AB, et al. J Diabetes Sci Technol 212;6:157 8
35 Remaining challenges
36 Average maximum exercise induced decline in plasma glucose, mg/dl Reducing exercise-induced hypoglycemia in patients using closed-loop therapy 1 1 T1DM patients underwent 24hr closedloop (CL) and closedloop + heart rate (CL+HR) control, with 3 min of exercise in the afternoon CL+HR control used a modified algorithm and was manually triggered when HR was 125% of resting CL+HR offers a route to reduce exerciseinduced hypoglycemia CL CL+HR p=.22 Hypoglycemia events exercise Low blood glucose index exercise Low blood glucose index overall Time in target (7-18mg/dL) exercise, % Time in target (7-18mg/dL) overall, % CL CL+HR p Breton MD, et al. Diabetes Technol Ther 214;16:56-511
37 Coping with the effect of meals on PPG Post-prandial excursions present a challenge in reactive systems because of the relatively slow action of insulins A meal announcement or bolus insulin is usually required Algorithms that can cope with PPG excursions are in development A fully-automated fuzzy logic controller has been shown to be potentially viable and adaptable by clinicians 1 Supplemental ultrafast-acting inhaled insulins taken at mealtimes may provide a solution An algorithm for this solution is in development 2 PPG, post prandial glucose 1. Mauseth R, et al. Diabetes Technol Ther 213;15: Cengiz E. J Diabetes Sci Technol 212;6:797-81
38 Improved insulin pharmacokinetics are required Factors that effect the absorption rate and action of rapid-acting insulins 1 Current rapid-acting insulins do not work quickly enough to mimic post-meal insulin secretion in healthy subjects Ultrafast-acting insulins will be required for reactive systems Insulin preparation Injection site Physical changes Dose Anatomical location Low blood sugar Physical properties of the Intramuscular injection vs. Ketoacidosis preparation subcutaneous injection Smoking vs. non-smoking Concentration and volume Lipodystrophy Metabolic control Origin of insulin (e.g. Changes in body animal, human, analogue) temperature Physical activity Increase in local blood flow Massage Injury Approaches to increase the absorption rate of rapid-acting insulins 1 Mechanical Increase of local blood flow (e.g. exercise, massage, heat) Alternative routes of insulin administration (e.g. inhalation, intradermal application) Mechanical or enzymatic distribution of insulin into a wider area of subcutaneous tissue Insulin preparation Addition of excipients to the insulin that increase absorption (e.g. excipients that increase the stability of insulin monomers, excipients that increase local blood flow) Novel rapid-acting insulin analogues 1. Adapted from Heinemann L, et al. J Diabetes Sci Technol 212;6:728 42
39 Integration of components into a single commercial device 1 To be suitable for large-scale outpatient studies, the following components need to be packaged into a single device Accurate and reliable CGM Reliable and user-friendly insulin pump Efficacious control algorithms These components are being developed separately within different companies and universities, and it is unlikely that any single company can provide all three components in the near future Business partnerships will be needed in order to integrate the components, perform clinical studies and carry out regulatory filings 1. Peyser T, et al. Ann N Y Acad Sci;214;1311:12 23
40 Summary Recent advances are demonstrating that a commercial artificial pancreas system should be a possibility in the near future The required components are: A CGM: increased accuracy is needed Insulin pump: increased reliability and better infusion sets required Algorithm: efficacious control algorithms need to be developed and identified Other obstacles include: Development of ultrafast-acting insulins Development of business relationships to obtain a commercial device
Artificial Pancreas Device System (APDS)
Medical Policy Manual Durable Medical Equipment, Policy No. 77 Artificial Pancreas Device System (APDS) Next Review: October 2019 Last Review: October 2018 Effective: November 1, 2018 IMPORTANT REMINDER
More informationThe artificial pancreas: the next step in connectivity and digital treatment of type 1 diabetes
The artificial pancreas: the next step in connectivity and digital treatment of type 1 diabetes Roman Hovorka PhD FMedSci University of Cambridge, UK Duality of interest declaration Advisory Panel: Research
More informationAdvances in Technology in the Treatment of Diabetes Mellitus 2017 How far have we come-how far are we going? Is there a final frontier?
Advances in Technology in the Treatment of Diabetes Mellitus 2017 How far have we come-how far are we going? Is there a final frontier? Alan B Schorr DO FAAIM FACE www.sugardoc.com abs@sugardoc.com Disclosures
More informationDiabetes Management: Current High Tech Innovations
Diabetes Management: Current High Tech Innovations How Far We ve Come in the Last 40 Years William V. Tamborlane, MD Department of Pediatrics Yale School of Medicine Disclosures I am a consultant for:
More informationThe Realities of Technology in Type 1 Diabetes
The Realities of Technology in Type 1 Diabetes May 6, 2017 Rosanna Fiallo-scharer, MD Margaret Frederick, RN Disclosures I have no conflicts of interest to disclose I will discuss some unapproved treatments
More informationArtificial Pancreas Device Systems. Populations Interventions Comparators Outcomes. pump. pump
Protocol Artificial Pancreas Device Systems (10130) Medical Benefit Effective Date: 04/01/18 Next Review Date: 01/19 Preauthorization Yes Review Dates: 03/15, 03/16, 03/17, 01/18 Preauthorization is required.
More informationFuture Direction of Artificial Pancreas. Roy W. Beck, MD, PhD. JAEB Center for Health Research Tampa, Florida
Future Direction of Artificial Pancreas Roy W. Beck, MD, PhD JAEB Center for Health Research Tampa, Florida Financial Disclosures Dr. Beck does not have any personal conflicts of interest His employer,
More informationArtificial Pancreas Device Systems. Populations Interventions Comparators Outcomes Individuals: With type 1 diabetes
Protocol Artificial Pancreas Device Systems Medical Benefit Effective Date: 07/01/18 Next Review Date: 01/20 Preauthorization Yes Review Dates: 03/15, 03/16, 03/17, 01/18, 05/18, 01/19 Preauthorization
More informationWhat is a CGM? (Continuous Glucose Monitor) The Bionic Pancreas Is Coming
The Bionic Pancreas Is Coming Montana Diabetes Professional Conference October 23, 2014 H. Peter Chase, MD Professor of Pediatrics University of Colorado Barbara Davis Center Stanford: Bruce Buckingham,
More informationHybrid Closed Loop Status & Practical Challenges in Implementation
Hybrid Closed Loop Status & Practical Challenges in Implementation Bruce Buckingham, MD Buckingham@Stanford.edu Professor of Pediatric Endocrinology Stanford School of Medicine Conflict of Interests Company
More informationDiabetes II Insulin pumps; Continuous glucose monitoring system (CGMS) Ernest Asamoah, MD FACE FACP FRCP (Lond)
Diabetes II Insulin pumps; Continuous glucose monitoring system (CGMS) Ernest Asamoah, MD FACE FACP FRCP (Lond) 9501366-011 20110401 Objectives Understand the need for insulin pumps and CGMS in managing
More informationCGM and Closing The Loop
CGM and Closing The Loop Dualities Research: Helmsely Charitable Trust, ADA, JDRF, NIDDK Consulting: Abbott Diabetes Care, Roche, Intarcia, Valeritas, Adocia, Big Foot Like With Pumps, We ve Come A Long
More informationPREVENTION OF NOCTURNAL HYPOGLYCEMIA USING PREDICTIVE LOW GLUCOSE SUSPEND (PLGS)
PREVENTION OF NOCTURNAL HYPOGLYCEMIA USING PREDICTIVE LOW GLUCOSE SUSPEND (PLGS) Pathways for Future Treatment and Management of Diabetes H. Peter Chase, MD Carousel of Hope Symposium Beverly Hilton, Beverly
More informationWhat is the role of insulin pumps in the modern day care of patients with Type 1 diabetes?
What is the role of insulin pumps in the modern day care of patients with Type 1 diabetes? Dr. Fiona Wotherspoon Consultant in Diabetes and Endocrinology Dorset County Hospital Fiona.Wotherspoon@dchft.nhs.uk
More informationSensor-augmented pump systems provide insulin delivery
DIABETES TECHNOLOGY & THERAPEUTICS Volume 18, Number 10, 2016 Mary Ann Liebert, Inc. DOI: 10.1089/dia.2016.0216 ORIGINAL ARTICLE Effectiveness of Automated Insulin Management Features of the MiniMed c
More informationControl of Glycemic Variability for Reducing Hypoglycemia Jae Hyeon Kim
Control of Glycemic Variability for Reducing Hypoglycemia Jae Hyeon Kim Division of Endocrinology and Metabolism, Samsung Medical Center, Sungkyunkwan University School of Medicine Conflict of interest
More informationDIABETES TECHNOLOGY: WHERE ARE WE NOW AND WHERE ARE WE GOING? Presented by: Tom Brobson
DIABETES TECHNOLOGY: WHERE ARE WE NOW AND WHERE ARE WE GOING? Presented by: Tom Brobson March 3 rd, 2018 Who is this guy? Accelerating Progress 1 Oh that guy! Accelerating Progress 2 STATE OF T1D CARE
More informationAdvances in Diabetes Care Technologies
1979 Advances in Diabetes Care Technologies 2015 Introduction Insulin pump use: ~ 20% - 30% of patients with T1DM < 1% of insulin-treated patients with T2DM 2007 FDA estimates ~375,000 insulin pumps for
More informationDiabetes Technology Update. Sarah Konigsberg, MD Diabetes & Endocrine Assoc. April 7, 2018
Diabetes Technology Update Sarah Konigsberg, MD Diabetes & Endocrine Assoc. April 7, 2018 Disclosures None No future technologies are FDA approved Continuous Glucose Monitors Continuous Glucose Monitors
More informationNEW TECHNOLOGIES FOR MANAGING DIABETES ANGELA THOMPSON DNP, FNP-C, BC-ADM, CDE, FAANP
NEW TECHNOLOGIES FOR MANAGING DIABETES ANGELA THOMPSON DNP, FNP-C, BC-ADM, CDE, FAANP No commercial support or sponsorship was received for this project I have nothing to disclose OBJECTIVES Identify at
More informationCAROLINAS CHAPTER/AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS Annual Meeting HILTON HEAD ISLAND FRIDAY PRESENTATION
CAROLINAS CHAPTER/AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS 2016 Annual Meeting HILTON HEAD ISLAND FRIDAY PRESENTATION September 9-11, 2016 ~ Sonesta Resort ~ Hilton Head Island, SC This continuing
More information[Frida Svendsen and Jennifer Southern] University of Oxford
In adolescents with poorly controlled type 1 diabetes mellitus, could a bionic, bihormonal pancreas provide better blood glucose control than continuous subcutaneous insulin infusion therapy? [Frida Svendsen
More informationSubject Index. Breastfeeding, self-monitoring of blood glucose 56
Subject Index Animas Vibe 86, 130 Artificial pancreas clinical studies inpatient studies 175 180 outpatient studies outcome assessment 182, 183 technology 180, 181 telemedicine 182 components glucose sensor
More informationSupplementary Appendix
Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Phillip M, Battelino T, Atlas E, et al. Nocturnal glucose control
More informationToday s Goals 10/6/2017. New Frontiers in Diabetes Technology. Disclosures
New Frontiers in Diabetes Technology Marie E. McDonnell, MD Director, Brigham and Women's Diabetes Program Division of Endocrinology, Diabetes and Hypertension Brigham and Women s Hospital Today s Goals
More informationGlucose Outcomes with the In-Home Use of a Hybrid Closed-Loop Insulin Delivery System in Adolescents and Adults with Type 1 Diabetes
DIABETES TECHNOLOGY & THERAPEUTICS Volume 19, Number 3, 2017 Mary Ann Liebert, Inc. DOI: 10.1089/dia.2016.0421 ORIGINAL ARTICLE Glucose Outcomes with the In-Home Use of a Hybrid Closed-Loop Insulin Delivery
More informationCareLink. software REPORT REFERENCE GUIDE. Management Software for Diabetes
CareLink Management Software for Diabetes software REPORT REFERENCE GUIDE How to use this guide Each type of CareLink report and its components are described in the following sections. Report data used
More informationThe next five years in diabetes technology: closed-loop systems
The next five years in diabetes technology: closed-loop systems J. H. (Hans) DeVries Academic Medical Center at the University of Amsterd, the Netherlands Keystone, CO, 19 July 2013 Disclosure AP@home,
More informationDiabetes through my eyes. Rick Mauseth, M.D. W.A.D.E. April 2013
Diabetes through my eyes Rick Mauseth, M.D. W.A.D.E. April 2013 Ant hills Total Available Glucose utilized Two drops of urine in test tube Add 10 drops of water Added tablet Foamed and got hot Compared
More informationJDRF Perspective on Closed Loop
JDRF Perspective on Closed Loop Aaron J. Kowalski, Ph.D. Assistant Vice President Treatment Therapies Juvenile Diabetes Research Foundation International 1 Presenter Disclosure Aaron Kowalski Disclosed
More informationPumps & Sensors made easy. OPADA ALZOHAILI MD FACE Endocrinology Assistant Professor Wayne State University
Pumps & Sensors made easy OPADA ALZOHAILI MD FACE Endocrinology Assistant Professor Wayne State University DeFronzo RA. Diabetes. 2009;58:773-795. Ominous Octet Relationship of b-cell Dysfunction and Development
More informationAbbott FreeStyle Libre Pro System
Professional CGM Abbott FreeStyle Libre Pro Reader Kit includes: Reader, USB cable, interactive tutorial on USB, and power adapter, user s manual, Quick Start Guide, Quick Reference Guide Kit includes:
More informationArtificial Pancreas Device Systems
Artificial Pancreas Device Systems Policy Number: 1.01.30 Last Review: 1/2019 Origination: 1/2017 Next Review: 1/2020 Policy Blue Cross and Blue Shield of Kansas City (Blue KC) will provide coverage for
More informationReport Reference Guide
Report Reference Guide How to use this guide Each type of CareLink report and its components are described in the following sections. Report data used to generate the sample reports was from sample patient
More informationTechnology in Diabetes Management Irl B. Hirsch, MD University of Washington
Technology in Diabetes Management 2016 Irl B. Hirsch, MD University of Washington Dualities Research: Helmsley Charitable Trust, JDRF, ADA, NIDDK, CDC Consulting: Abbott, Roche, Intarcia Raise Your Hand
More informationAdvances in Diabetes Care Technologies
1979 Advances in Diabetes Care Technologies 2015 Introduction Roughly 20% - 30% of patients with T1DM and fewer than 1% of insulin-treated patients with T2DM use an insulin pump In 2007, the US FDA estimated
More informationReport Reference Guide. THERAPY MANAGEMENT SOFTWARE FOR DIABETES CareLink Report Reference Guide 1
Report Reference Guide THERAPY MANAGEMENT SOFTWARE FOR DIABETES CareLink Report Reference Guide 1 How to use this guide Each type of CareLink report and its components are described in the following sections.
More informationThe Growing Future of Diabetes: Insulin Pump Therapy in Type 1 and 2 Diabetes
The Growing Future of Diabetes: Insulin Pump Therapy in Type 1 and 2 Diabetes Sarah Dombrowski, PharmD, BCACP Pennsylvania Pharmacists Association 10/20/18 1 Objectives At the completion of this activity,
More informationUNDERSTANDING THE BASIC FEATURES AND MANAGEMENT IN THE SCHOOL SETTING CHRISTINE HERTLER RN BSN CDE & MARY MCCARTHY RN CDE
UNDERSTANDING THE BASIC FEATURES AND MANAGEMENT IN THE SCHOOL SETTING CHRISTINE HERTLER RN BSN CDE & MARY MCCARTHY RN CDE The insulin pump Replaces injections Delivers insulin through a soft cannula
More informationAdvances in Diabetes Care Technologies
Advances in Diabetes Care Technologies 1979 2015 Introduction Roughly 20% to 30% of patients with T1DM and fewer than 1% of insulin-treated patients with T2DM use an insulin pump In 2007, the U.S. FDA
More informationArtificial Pancreas Technologies: New Tools to Improve Diabetes Care Today and Tomorrow
Artificial Pancreas Technologies: New Tools to Improve Diabetes Care Today and Tomorrow Mark D. DeBoer, MD, MSc., MCR University of Virginia Center for Diabetes Technologies October 2017 Learning Objectives
More information1 Dexcom G4 Platinum User Guide May 2012
1 Dexcom G4 Platinum User Guide May 2012 Page 1. Dexcom G4 PLATINUM Continuous Glucose Monitoring System. CE marked for use in 1Dexcom G4 User Guide, May 2012. LBL-011277 Rev04. color display. Dexcom G4
More informationWHEN YOUR PANCREAS IS NOT A HAPPY CAMPER A PRESENTATION ON DIABETES MANAGEMENT IN THE CAMP SETTING AMANDA COSCHI, BSCN, RN, CDE
WHEN YOUR PANCREAS IS NOT A HAPPY CAMPER A PRESENTATION ON DIABETES MANAGEMENT IN THE CAMP SETTING AMANDA COSCHI, BSCN, RN, CDE MAY 5, 2018 OBJECTIVES Strong understanding of diabetes and its management
More informationApproved by: Integrated Health Quality Management Subcommittee Effective Date: Department of Origin: Integrated Healthcare Services.
Reference #: MC/L008 Page: 1 of 8 PRODUCT APPLICATION: PreferredOne Community Health Plan (PCHP) PreferredOne Administrative Services, Inc. (PAS) ERISA PreferredOne Administrative Services, Inc. (PAS)
More informationMEDICAL POLICY Continuous Glucose Monitoring Systems and Insulin Pumps
POLICY: PG0177 ORIGINAL EFFECTIVE: 12/01/08 LAST REVIEW: 02/13/18 MEDICAL POLICY Continuous Glucose Monitoring Systems and Insulin Pumps GUIDELINES This policy does not certify benefits or authorization
More informationAnimas Vibe System World-class insulin pumping meets world-class CGM*
Animas Vibe System World-class insulin pumping meets world-class CGM* Fully integrated with Dexcom G4 PLATINUM CGM* *Continuous glucose monitoring. My Animas pump has really put me in the driver s seat
More informationMedical Policy. MP Artificial Pancreas Device Systems
Medical Policy MP 1.01.30 BCBSA Ref. Policy: 1.01.30 Last Review: 01/30/2018 Effective Date: 04/01/2018 Section: Durable Medical Equipment Related Policies 1.01.20 Continuous or Intermittent Monitoring
More informationInsulin Pumps and Continuous Glucose Sensors- Embracing Technology. Susan Cavalier, BS, RN, CDE Manager, Diabetes Educator Sanford Diabetes Education
Insulin Pumps and Continuous Glucose Sensors- Embracing Technology Susan Cavalier, BS, RN, CDE Manager, Diabetes Educator Sanford Diabetes Education Diabetes Management Tools in 1974 Insulin pump history
More informationDiabetes and Technology. Saturday, September 9, 2017 Aimee G sell, APRN, ANP-C, CDE
Diabetes and Technology Saturday, September 9, 2017 Aimee G sell, APRN, ANP-C, CDE Disclosure Speaker s Bureau: Janssan Pharmaceuticals Current Technology V-Go by Valeritas Continuous Sensors (personal
More information10:20 AM March 5, B 100% 235 u. 124 mg/dl 3 HRS INSULIN ON BOARD:
DEXCOM G5 MOBILE CGM COMPATIBLE B 100% 235 u INSULIN ON BOARD: OPTIONS 10:20 AM March 5, 2017 400 350 300 250 200 150 100 50 1.1 u 1:09 hrs BOLUS 124 mg/dl 3 HRS The pump that gets updated, not outdated.
More informationInsulin Pump Therapy in children. Prof. Abdulmoein Al-Agha, FRCPCH(UK)
Insulin Pump Therapy in children Prof. Abdulmoein Al-Agha, FRCPCH(UK) aagha@kau.edu.sa Highlights Evolution of insulin pump Pumps mimics Pancreas Goals of diabetes care What lowers HbA1c Criteria for selection
More informationEffect of Insulin Feedback on Closed-Loop Glucose Control: A Crossover Study
Journal of Diabetes Science and Technology Volume 6, Issue 5, September 2012 Diabetes Technology Society ORIGINAL ARTICLE Effect of Insulin Feedback on Closed-Loop Glucose Control: A Crossover Study Jessica
More informationDr Sander Zwart MD, FACP, ECNU Arizona-AACE 2016 Annual Meeting
Dr Sander Zwart MD, FACP, ECNU Arizona-AACE 2016 Annual Meeting Disclaimers None Except products and software discussed are all proprietary, so if I mention a brand product it is because there is no other
More informationEmerging Automated Insulin Delivery Systems
Emerging Automated Insulin Delivery Systems Richard M. Bergenstal, MD International Diabetes Center Park Nicollet & HealthPartners Minneapolis, MN Presenter Name 1 Dualities: Richard M. Bergenstal, MD
More informationNEWS BRIEFING Advances in Technology. moderated by: Irl Hirsch, MD University of Washington Medical Center
NEWS BRIEFING Advances in Technology moderated by: Irl Hirsch, MD University of Washington Medical Center 1 EMBARGO POLICY All recordings are for personal use only and not for rebroadcast online or in
More informationDISCOVER THE POWER OF CONNECTION MINIMED 640G
DISCOVER THE POWER OF CONNECTION MINIMED 640G INSULIN PUMP THERAPY CHANGING LIVES TODAY Have you just been diagnosed with insulin dependent diabetes? Perhaps you ve been on multiple daily injection therapy
More informationPreventing Hypoglycemia Using Predictive Alarm Algorithms and Insulin Pump Suspension
DIABETES TECHNOLOGY & THERAPEUTICS Volume 11, Number 2, 29 Mary Ann Liebert, Inc. DOI: 1.189/dia.28.32 Preventing Hypoglycemia Using Predictive Alarm Algorithms and Insulin Pump Suspension Bruce Buckingham,
More informationDexcom Current and Future Technology Innovations. Jorge Valdes Chief Technical Officer
Dexcom Current and Future Technology Innovations 2015 Jorge Valdes Chief Technical Officer G5 App Sensor (Same as G4) Indicated for adults and children down to Age 2 years Tiny insertion needle (26Ga)
More informationPaolo Di Bartolo U.O di Diabetologia Dip. Malattie Digestive & Metaboliche AULS Prov. di Ravenna. Ipoglicemie e Monitoraggio Glicemico
Paolo Di Bartolo U.O di Diabetologia Dip. Malattie Digestive & Metaboliche AULS Prov. di Ravenna Ipoglicemie e Monitoraggio Glicemico Management of Hypoglycaemia.if hypoglycemia is a problem, the principles
More informationDiabetes Management Continuous Glucose Monitoring
Progress with Closed-loop Systems in Type 1 Diabetes Lalantha Leelarathna 1 and Roman Hovorka 2 1. Clinical Research Associate; 2. Principal Research Associate, Institute of Metabolic Science, University
More informationNorbert Hermanns, PhD 1,2, Beatrix Schumann, MD 2, Bernhard Kulzer, PhD 1,2, and Thomas Haak, MD 1,2. Original Article
524105DSTXXX10.1177/1932296814524105Journal of Diabetes Science and TechnologyHermanns et al research-article2014 Original Article The Impact of Continuous Glucose Monitoring on Low Interstitial Glucose
More informationReduced Hypoglycemia and Increased Time in Target Using Closed-Loop Insulin Delivery During Nights With or Without Antecedent Afternoon Exercise
Clinical Care/Education/Nutrition/Psychosocial Research O R I G I N A L A R T I C L E Reduced Hypoglycemia and Increased Time in Target Using Closed-Loop Insulin Delivery During Nights With or Without
More informationPredicts and helps prevent lows with. zero fingersticks NOW FEATURING BASAL-IQ TECHNOLOGY
Predicts and helps prevent lows with * zero fingersticks NOW FEATURING BASAL-IQ TECHNOLOGY Basal-IQ Technology is not a substitute for active self-management of your diabetes. Please see back cover for
More informationThe Harvard community has made this article openly available. Please share how this access benefits you. Your story matters
Safety and Feasibility of the OmniPod Hybrid Closed-Loop System in Adult, Adolescent, and Pediatric Patients with Type 1 Diabetes Using a Personalized Model Predictive Control Algorithm The Harvard community
More informationNational Medical Policy
National Medical Policy Subject: Policy Number: Continuous Glucose Monitoring Devices NMP333 Effective Date*: January 2007 Updated: June 2017 This National Medical Policy is subject to the terms in the
More informationQUESTION 4. WHAT CLINICAL DATA ARE CURRENTLY AVAILABLE TO SUPPORT EXPANDED CGM COVERAGE BY PAYERS AS PERTAINS TO QUESTIONS 1 AND 3?
500 1 QUESTION 4. WHAT CLINICAL DATA ARE CURRENTLY AVAILABLE TO SUPPORT EXPANDED CGM COVERAGE BY PAYERS AS PERTAINS TO QUESTIONS 1 AND 3? WHAT ADDITIONAL DATA ARE NEEDED? AACE/ACE CGM Consensus Conference:
More informationInsulin Pumps and Glucose Sensors in Diabetes Management
Diabetes Update+ 2014 Congress Whistler, British Columbia Friday March 21, 2014ǀ 8:15 8:45 am Insulin Pumps and Glucose Sensors in Diabetes Management Bruce A Perkins MD MPH Division of Endocrinology Associate
More informationBringing closed-loop home: recent advances in closed-loop insulin delivery
REVIEW C URRENT OPINION Bringing closed-loop home: recent advances in closed-loop insulin delivery Hood Thabit and Roman Hovorka Purpose of review To highlight the recent advances in closed-loop research,
More informationPresented by Dr. Bruce Perkins, MD MPH Dr. Michael Riddell, PhD
Type 1 Diabetes and Exercise: Optimizing the Medtronic MiniMed Veo Insulin Pump and Continuous Glucose Monitoring (CGM) for Better Glucose Control 1,2 for Healthcare Professionals Presented by Dr. Bruce
More informationArtificial Pancreas, shortly close to home? BC Pediatric Diabetes Day, Feb 26, 2016
Artificial Pancreas, shortly close to home? BC Pediatric Diabetes Day, Feb 26, 2016 Rémi Rabasa- Lhoret, M.D. (Endocrinology), Ph.D. CSPQ Director Pla:orm for Research in Obesity, Metabolism and Diabetes
More informationPerformance-powered. The OneTouch. Ping insulin pump and meter-remote.
Performance-powered. The OneTouch Ping insulin pump and meter-remote. I We don t just deliver insulin. We deliver outstanding clinical performance. P36337_OTP_DetAid_OmniPodUpdate_r12.indd 1 OneTouch Ping.
More informationAnneli, Martina s daughter In better control with her pump since 2011 MY CHILD HAS TYPE 1 DIABETES
Anneli, Martina s daughter In better control with her pump since 2011 MY CHILD HAS TYPE 1 DIABETES Many parents whose child is diagnosed with Type 1 diabetes wonder: Why is this happening to my child?
More informationAdvances Towards the Bionic Pancreas.
Advances Towards the Bionic Pancreas. Ron Brazg MD, FACE Rainier Clinical Research Center Renton, WA DISCLOSURES Rainier Clinical Research Center is an independent research facility not directly affiliated
More informationAbbott FreeStyle Libre Pro System
, the Professional CGM Abbott FreeStyle Libre Pro Reader Kit includes: Reader, USB cable, interactive tutorial on USB, and power adapter, user s manual, Quick Start Guide, Quick Reference Guide Kit includes:
More informationWelcome to CareLink Pro
Reference Guide Welcome to CareLink Pro This guide was developed to serve as a reference for obtaining patient data and reviewing CareLink Pro reports. Getting Started with CareLink Pro Adding New Patients
More informationMEDICAL POLICY Continuous Glucose Monitoring Systems and Insulin Pumps
POLICY: PG0177 ORIGINAL EFFECTIVE: 12/01/08 LAST REVIEW: 05/24/18 MEDICAL POLICY Continuous Glucose Monitoring Systems and Insulin Pumps GUIDELINES This policy does not certify benefits or authorization
More informationWhen Will CGM Replace SMBG? Roy W. Beck, MD, PhD. JAEB Center for Health Research Tampa, Florida
When Will CGM Replace SMBG? Roy W. Beck, MD, PhD JAEB Center for Health Research Tampa, Florida Financial Disclosures Dr. Beck does not have any personal conflicts of interest His employer, the JAEB Center
More informationA Review of Safety and Design Requirements of the Artificial Pancreas
Annals of Biomedical Engineering, Vol. 44, No. 11, November 2016 ( 2016) pp. 3158 3172 DOI: 10.1007/s10439-016-1679-2 A Review of Safety and Design Requirements of the Artificial Pancreas HELGA BLAUW,
More informationHypoglycemia a barrier to normoglycemia Are long acting analogues and pumps the answer to the barrier??
Hypoglycemia a barrier to normoglycemia Are long acting analogues and pumps the answer to the barrier?? Moshe Phillip Institute of Endocrinology and Diabetes National Center of Childhood Diabetes Schneider
More informationWHAT CAN I DO TO REDUCE MY RISK OF DEVELOPING THE COMPLICATIONS OF TYPE 1 DIABETES?
Christian In better control with his pump since 2012 WHAT CAN I DO TO REDUCE MY RISK OF DEVELOPING THE COMPLICATIONS OF TYPE 1 DIABETES? Many people with Type 1 diabetes worry about potential long-term
More informationTechnology for Diabetes: 101 Basic Rules of the Road. Karen Hamon RN, BSN, CDE Stephen Stone MD, FAAP Neil H. White, MD, CDE
Technology for Diabetes: 101 Basic Rules of the Road Karen Hamon RN, BSN, CDE Stephen Stone MD, FAAP Neil H. White, MD, CDE Quick Pump Facts! o Constant insulin supply o Pager-sized mini-computer worn
More informationTHERAPY MANAGEMENT SOFTWARE FOR DIABETES
THERAPY MANAGEMENT SOFTWARE FOR DIABETES Report Report Interpretation Reference Guide Guide 2009 Medtronic MiniMed. All rights reserved. 6025274-012_a CareLink Pro Report Reference Guide 0 p.2 Adherence
More informationThe In-Clinic Close Loop Experience in the US
The In-Clinic Close Loop Experience in the US Keystone Symposium, Practical Ways to Achieve Targets in Diabetes Care July 14, 2012 Francine Ratner Kaufman, MD Chief Medical Officer, VP Global Medical,
More informationSponsor / Company: Sanofi Drug substance(s): insulin glargine (HOE901) According to template: QSD VERSION N 4.0 (07-JUN-2012) Page 1
These results are supplied for informational purposes only. Prescribing decisions should be made based on the approved package insert in the country of prescription. Sponsor / Company: Sanofi Drug substance(s):
More informationTHERAPY MANAGEMENT SOFTWARE FOR DIABETES
THERAPY MANAGEMENT SOFTWARE FOR DIABETES Report Report Interpretation Reference Guide Guide 2007 Medtronic MiniMed. All rights reserved. 6025274-0U2 120707 CareLink Pro Report Reference Guide 0 p.2 Sensor
More informationREPORT INTERPRETATION
REPORT INTERPRETATION: Interpreting ipro Professional Continuous Glucose Monitoring (CGM) Reports and Making Therapy Adjustments TARGET AUDIENCE The audience for this section is physicians, mid-level practitioners,
More informationDoes Technology helps adolescents with type 1 diabetes in fasting Ramadan?
Does Technology helps adolescents with type 1 diabetes in fasting Ramadan? Abdulmoein Al-Agha, FRCPCH Professor of Paediatric Endocrinology, King Abdulaziz University Hospital, http://aagha.kau.edu.sa
More informationContinuous Glucose Monitoring Devices Pharmacy Policy
Line of Business: All Line of Business Effective date: August 16, 2017 Revision date: August 16, 2017 Continuous Glucose Monitoring Devices Pharmacy Policy This policy has been developed through review
More informationUpdates in Diabetes Technology
Updates in Diabetes Technology Jessica Kirk, MSN, RN, CPN, CDE Nurse Manager, Endo ECHO No disclosures Disclosures 1 Objectives Distinguish patients appropriate for continuous glucose monitoring and insulin
More informationMaking the Most of Continuous Glucose Monitoring
Making the Most of Continuous Glucose Monitoring Gary Scheiner MS, CDE Owner & Clinical Director Integrated Diabetes Services LLC Wynnewood, PA AADE 2014 Diabetes Educator of the Year gary@integrateddiabetes.com
More informationRELEASED. first steps. Icon Icon name What it means
Icon Icon name What it means Connection The connection icon appears green when the Sensor feature is on and your transmitter is successfully communicating with your pump. The connection icon appears gray
More informationPump Basics for the School Nurse. Children's Endocrinology Center of Dallas
Pump Basics for the School Nurse Children's Endocrinology Center of Dallas Pump Basics Covers: A general overview of the insulin pump Refer to the manufacturer s website for the specific features of each
More informationAutomated control of an adaptive bi-hormonal, dual-sensor artificial pancreas and evaluation during inpatient studies
TBME-XXXX-XXXX (IN PRESS, 2014) 1 Automated control of an adaptive bi-hormonal, dual-sensor artificial pancreas and evaluation during inpatient studies Peter G. Jacobs, Member, IEEE, Joseph El Youssef,
More informationAmbulatory Artificial Pancreas Platform (AAPP) User Manual
Ambulatory Artificial Pancreas Platform (AAPP) User Manual Welcome to the Artificial Pancreas User Manual. This manual is intended to teach you how to use the system in your clinical trial. If questions
More informationDISCOVER THE POWER OF CONNECTION MINIMED 640G
DISCOVER THE POWER OF CONNECTION MINIMED 640G INSULIN PUMP THERAPY CHANGING LIVES TODAY Has your child just been diagnosed with insulin dependent diabetes? Or perhaps they ve been on multiple daily injection
More informationReal-Time Continuous Glucose Monitoring: From Application to Evaluation
Real-Time Continuous Glucose Monitoring: From Application to Evaluation Gary Scheiner MS, CDE Owner/Director, Integrated Diabetes Services 333 E. Lancaster Ave., Suite 24 Wynnewood, PA 1996 (877) 735-3648
More informationDIABETES & ENDOCRINE DIABETES TECHNOLOGY: HOW TO STAY CURRENT WITH ONGOING TECHNOLOGY ADVANCEMENT
DIABETES TECHNOLOGY: HOW TO STAY CURRENT WITH ONGOING TECHNOLOGY ADVANCEMENT Min-Jye Chen, MD Endocrinology Diabetes Management of the School-Aged Child Provided by Texas Children s Hospital Provider #18-267764-A
More information1. Continuous Glucose Monitoring
1. Continuous Glucose Monitoring 1. Physiology of interstitial fluid glucose 2. Comparison of CGM and self-monitored blood glucose (SMBG) data 3. Insulin dosing indication in BGM vs. CGM & the FDA 4. Protection
More informationDate of birth: Type 2 Other: Parent/guardian 1: Address: Telephone: Home: Work: Cell: address: Camper physician / health care provider:
Day & Evening Camp 2018 Specialized Health Care Diabetes Medical Management Plan Must be completed if your camper has diabetes. Parent/guardian and physician signature required. **We will also accept copies
More informationMEDICAL POLICY Continuous Glucose Monitoring Systems and Insulin Pumps
POLICY: PG0177 ORIGINAL EFFECTIVE: 12/01/08 LAST REVIEW: 07/10/18 MEDICAL POLICY Continuous Glucose Monitoring Systems and Insulin Pumps GUIDELINES This policy does not certify benefits or authorization
More information