Hybrid closed-loop system improves HbA1c for adults missing meal boluses
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SAN DIEGO — Use of an automated insulin delivery system can lower HbA1c and improve time in range without increasing time below range for people with type 1 diabetes who tend to miss meal boluses, according to a speaker.
“Generally, type 1 diabetes patients with a high HbA1c or those who are missing meal boluses frequently are not considered a good candidate for insulin pump or automated insulin delivery therapy,” Viral N. Shah, MD, associate professor of medicine and pediatrics at the Barbara Davis Center for Diabetes at the University of Colorado Anschutz Medical Campus, told Healio. “However, our study suggests that an automated insulin delivery system can safely be started in such patients and may lead to improved outcomes.”
Shah and colleagues analyzed the long-term outcomes with use of the Tandem Control-IQ hybrid closed-loop automated insulin delivery system by 30 adults with type 1 diabetes. Adults who had type 1 diabetes for at least 2 years, were missing meal boluses and had used a continuous glucose monitor for at least 6 months prior to the study were included. Participants were randomly assigned to a high auto mode group with no user-initiated boluses, a group using auto mode 50% to 90% of the time with an intermediate number of user-initiated boluses, and a group using auto mode less than half of the time with a high number of user-initiated boluses. CGM and insulin delivery data were obtained every 3 months for 1 year. HbA1c and time in range were used to assess efficacy.
The findings were presented at the AACE Annual Scientific and Clinical Conference.
All three groups had a baseline HbA1c of 9% or higher and baseline time in range of less than 50%. A significant reduction in HbA1c at 3, 6 and 12 months was observed for all three groups, and all groups had a mean HbA1c reduction of at least 1% at 12 months. Time in range significantly increased by at least 10% from baseline to 12 months in all three groups.
All three groups had minimal changes in body weight and insulin dose from baseline to 12 months. Time below range decreased slightly for all three groups during the study to 2% at 12 months for the group using auto mode the least, 1.8% for the intermediate auto mode group and 1.9% for the high auto mode group.
“Bolusing is an essential component of automated insulin delivery — that’s why it’s called a hybrid closed-loop system,” Shah said. “However, we demonstrate in our study that Tandem Control-IQ may be used in certain patients with type 1 diabetes even without user-initiated boluses, such as a fully automated insulin delivery system. I am sure this may surprise many providers.”
Shah said future studies should examine the efficacy of automated insulin delivery systems in high-risk populations, including those with a high HbA1c, people with less frequent boluses and older adults with comorbidities.
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Shah V, et al. Efficacy and Safety of Tandem Control IQ Without User-Initiated Boluses in Adults with Uncontrolled Type 1 Diabetes. Presented at: American Association of Clinical Endocrinology Annual Scientific and Clinical Conference; May 12-14, 2022; San Diego.
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