Dr Mark Evans CamAPS, Free online Desang diabetes magazine for the UK by Sue Marshall, diabetes info

35

KIT

sensors and batteries, as needed.

We call this 'housekeeping'. The

users need to also be aware of

the limitations of the systems; for

example, in times of illness or when

undertaking heavy exercise."

Fast track

Hopefully the current systems can

be further improved in the future,

maybe by needing few, or zero

calibrations, being more accurate

or through advances in insulin. For

some people with diabetes, they

would want insulin that works faster;

for other people with diabetes it

might be a longer-acting insulin

that they would benefit from, maybe

a background insulin that only

needs injecting on a weekly basis.

There may also be a use or need for

other insulins, which may be oral

or inhaled.

Implementing new technology

does come with its own challenges.

Notes Evans, "It seems that getting

a CE Mark is not that hard; it's a

relatively low bar. From that point on,

it's a matter of upscaling production

and of quality control. At which

point it can be said that this is not

always great."

So then we asked, what's coming

down the pike in terms of other

advances in closed-looping, Evans

responded, "Coming soon from

Insulet is the Omnipod Horizon

(sometimes referred to as Omnipod

5), which is likely to be integrated

with the Libre 3 sensor, which is not

available in the UK yet. Medtronic

is continuing to move towards a

'personalised closed-loop' system

that responds to each individual

user. Tandem is rumoured to be

developing a pump called the

T-sport, which has no screen on the

pump and is expected to integrated

with the Libre 3 sensor. Ypsomed is

due to integrate with Dexcom CGM,

but as far as is known, only in the US,

using the company's Ypsopump. Beta

Bionics continues to work on a bihormonal pump, which will include

the ability to infuse glucagon* from

the system if someone is going low,

which means they will not have to

rely on having 'rescue carbs' always

to hand. Eli Lilly is developing an

insulin pump for long-acting insulin,

which will just be a round, screenless device

that can be set to deliver

over the period of a week or so and

needs no user involvement once

it's on. Meanwhile Roche is working

with two other systems namely

Diabeloop and Type Zero which are

both algorithms."

The DIY-ers

Then those are those enterprising

souls who are operating off-licence,

setting up their own systems

involving the same items: a CGM

sensor, an algorithm and an insulin

pump. It is estimated that about 300-

400 people in the UK are currently

using DIY APS, at the moment, but

Evans admits that, "To an extent DIY

APS is somewhat off the grid."

Despite all this tech, Evans feels

that the biggest impact for Type

I diabetes for adults in the last 20

years has in fact been structured

education programmes. The year

2020 saw 20 years of DAFNE (an

education course based on Dose

Adjustment For Normal Eating).

There is also a virtual, free 'Bertie'

course. He says, "I'm extremely proDAFNE.

Whether using technology

or not, it really helps to understand

how insulin works and how your

body reacts to different challenges.

Tech has moved on immensely,

and continues to do so, but human

contact is still vital for most of us."

DAFNE

www.dafne.nhs.uk

Bertie

www.bertieonline.org.uk

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