| Abstract [eng] |
As technologies used to treat type 1 diabetes improve, healthcare professionals need to understand their likely benefits and limitations. Despite rapid developments, the effect of these technologies on key objective indicators of glycaemic control has not been consistently summarised. Aim. Evaluate the impact of type 1 diabetes technology tiers on key glycaemic control indicators: glycated haemoglobin, time in target range, time above target range, and time below target range, based on the scientific literature. Objectives. To identify the main type 1 diabetes treatment technologies and their stages of development. To evaluate the principles of operation, clinical applications, advantages, and limitations of these technologies. To select and systematise scientific studies assessing the impact of different type 1 diabetes treatment technologies on main glycaemic control indicators. To compare how different therapy stages for type 1 diabetes affect key glycaemic indicators. To assess the significance of the results for current clinical practice in the treatment of type 1 diabetes. Methods. A narrative literature review was conducted. The literature search was performed in PubMed, EBSCO (including MEDLINE, Academic Search Ultimate, and CINAHL Ultimate), and Clarivate Web of Science databases. Publications were selected by inclusion and exclusion criteria. A total of 25 studies were included in the final analysis. Results. In comparisons between capillary blood glucose measurements and continuous glucose monitors among individuals using multiple daily insulin injections, continuous glucose monitors demonstrated benefits such as increased time in the target range, reduced time below the target range, and lower glycated haemoglobin levels. Comparisons between multiple daily insulin injections and continuous subcutaneous insulin infusion indicated that insulin pumps provided modest advantages in some studies, with no consistent benefit across all glycaemic parameters. The most clear improvements in glycaemic parameters were observed when comparing sensor-augmented insulin pumps with automated insulin pumps, resulting in increased time in the target range, reduced time above the target range, minimal impact on time below the target range, and lower glycated haemoglobin in some studies. Although the literature on open-loop systems was more heterogeneous, the advantages over less advanced technologies were apparent. Conclusions. Most technologies used in the treatment of type 1 diabetes are associated with improved glycaemic control compared to less advanced options, although the size of benefit varies. The greatest improvements in glycaemic parameters were observed in the automated insulin delivery system. |
