CamDiab Project

Context

In Scotland, nearly 20% of hospital inpatients have diabetes, and hyperglycaemia is associated with increased complications, longer hospital stays, and higher mortality. Yet achieving optimal glucose control in hospital remains a challenge due to time constraints on staff, variability in clinical pathways, and lack of standardised insulin delivery approaches.

Problem

Currently, the management of insulin therapy in hospitalised adults with non-Type 1 diabetes follows a manual, labour-intensive, and reactive approach. Inpatient glycaemic control relies on subcutaneous insulin administered by nursing staff or variable rate intravenous insulin infusions (VRII), both of which require frequent capillary blood glucose (CBG) checks, manual dose adjustments, and significant staff time and attention.

Solution

The proposed solution is the use of a fully closed-loop glucose control system; CamAPS HX, to improve inpatient glycaemic management for adults with type 2 diabetes. This system integrates three key technologies: the CamAPS HX algorithm hosted on an Android smartphone, the Dexcom G6 continuous glucose monitor (CGM), and the Ypsopump insulin pump. The system automatically adjusts insulin delivery in real time, removing the need for manual intervention or frequent capillary blood glucose testing and insulin dosing.

The innovation lies in bringing this clinically validated, autonomous glucose management technology, originally developed for outpatient use, into the inpatient setting, where diabetes management remains suboptimal. This solution offers a paradigm shift from reactive to proactive and adaptive glucose management.

Evaluation

The performance of the CamAPS HX closed-loop insulin delivery system was evaluated during a 3-month pilot in two wards at the Western General Hospital in Edinburgh. The objective was to determine whether the technology could safely improve glycaemic control, reduce clinical burden, and demonstrate feasibility for broader NHS Scotland adoption. The evaluation focused on six core areas: efficacy, safety (including hypoglycaemia), system usage, clinical workload, patient acceptance, and cost analysis. Evaluation was limited due to low patient numbers.

Results