While clinical trials demonstrate the effectiveness of innovations such as Hybrid Closed Loop and continuous glucose monitoring (both real time and flash glucose monitoring) translating clinical trial outcomes to the real world experience has not produced consistent outcomes. In Australia, increased access to continuous glucose monitoring has resulted in both consumer and endocrinologist input to diabetes care outcomes. Outcomes in turn will be influenced by consumer and endocrinologist engagement with technology and perceived benefits of the technology.
To provide appropriate support to consumers it is critical for Endocrinologists to have an understanding of how each technology works, its benefits and limitations. It is important that technology when introduced reduces treatment burden. High rates of discontinuation of CGM occur both in those using Hybrid closed loop (which depends on CGM) and in those whose diabetes therapy does not rely on CGM for management.
New innovations in insulin delivery will reduce insulin infusion set failures, will incorporate insulin with more rapid onset to action and will reduce alarm fatigue. Different mathematical models of hybrid closed loop may mean that different models suit different individuals and at this stage we have no head to head comparisons of closed loop devices. Increased time in target (3.9-10 mmol/L) will become the new clinical measure to monitor as complications outcomes will be tied to time in range instead of the imperfect glycosylated haemoglobin.