In-hospital use of Automated Insulin Delivery (AID): Current state and future potential - PROJECT SUMMARY/ABSTRACT Dr. Michael Hughes, an instructor in Stanford University's Division of Endocrinology, Gerontology, and Metabolism, is motivated by his personal experience living with type 1 diabetes to improve care and outcomes for individuals with the condition. He has recognized the potential of automated insulin delivery (AID) systems to enhance care for hospitalized patients with diabetes, based on both individual experience in caring for these patients and the encouraging results from collaboration in a recent pilot study. This K23 grant will support Dr. Hughes in developing expertise as an independent clinical researcher to use AID to improve patient care in the hospital by providing a structured research program, targeted training, and personalized mentorship. Hospitalized patients with diabetes are at higher risk of complications and death due to unstable blood sugar levels. Traditional insulin therapy using multiple daily injections often fails to control blood sugar in the hospital and results in high rates of both high blood sugar (hyperglycemia) and low blood sugar (hypoglycemia). Despite 20 years of limited advancements in hospital diabetes care, advancements in diabetes technology have been remarkably successful in outpatient settings. Recent trials testing the use of continuous glucose monitors in the hospital have marginally reduced hypoglycemia without reducing hyperglycemia. AID systems, however, offer a promising solution. They use real-time glucose data to adjust insulin delivery up to 288 times a day, providing a level of control and adaptation not possible with traditional insulin therapy methods. While some patients already use their personal AID systems in the hospital, there are limited data from these experiences and no systematically established guidance to support this use. The objective of the research in this proposal is to examine and optimize inpatient AID use. The research aims to (1) evaluate the effectiveness of continuing home AID systems in the hospital among people with T1D, (2) qualitatively identify and classify the barriers and facilitators associated with its use, and (3) develop implementation strategies to advance and de-risk the use of AID systems in the hospital. This will provide foundational data on the potential and limitations of current AID systems and advance their use in the hospital. Dr. Hughes has assembled a highly qualified team of mentors and advisors who are experts in diabetes, diabetes technology, inpatient diabetes management, qualitative and implementation science research, clinical informatics, hospital technology integration, and hospital medicine. The strategic combination of coursework in research methods and qualitative techniques, along with the Master of Science in Clinical Informatics Management, will equip Dr. Hughes with the necessary skills to effectively integrate technology into the hospital setting. Through the mentorship, training, and research proposed, Dr. Hughes will position himself as a leading expert and use this opportunity to establish himself as an independent physician-scientist.
