Automated insulin delivery improves time in range for children with type 1 diabetes
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Children with type 1 diabetes who switched from a predictive low-glucose suspend system to automated insulin delivery had improvements in time in range at 1 month that were sustained at 3 months, according to a speaker.
In findings from a real-world study, children aged 1 to 13 years with type 1 diabetes used the t:slim X2 insulin pump with Control-IQ technology (Tandem Diabetes Care) for 3 months. In addition to a higher time in range across all age groups, the cohort maintained a time below range of less than 2%, and participants performed fewer manual correction boluses per day with automated insulin delivery compared with a predictive low-glucose suspend system.
“Glycemic control improved in a large cohort of young children across the U.S. using this automated insulin delivery system in the real world, similar to published study outcomes,” Melissa Schoelwer, MD, associate professor of pediatrics at the University of Virginia, told Healio. “Providers can expect to see a gain of about 13% time in range on this system in children. They can use this data to counsel patients and families and set realistic expectations on how automated insulin delivery use will impact glycemic control.”
Researchers enrolled 2,340 children aged 1 to 13 years with type 1 diabetes to participate in the study. After using a predictive low-glucose suspend system for 1 month, the cohort switched to automated insulin delivery for 3 months. Continuous glucose monitoring metrics and insulin pump data were collected. Outcomes were analyzed during the 1 month before automated delivery began and at 1 month and 3 months with automated insulin delivery. Participants were stratified across three age groups: 1 to 5 years, 6 to 10 years and 11 to 13 years.
Participants increased time in range between 70 mg/dL and 180 mg/dL from 50% with the low-glucose suspend system to 65% at 1 month and 63% at 3 months with automated insulin delivery. Increases in time in range were observed among all three age groups. There was no increase in time spent below 70 mg/dL, though time below range was longer among children aged 1 to 5 years than in the two older age groups throughout the study.
“With the introduction of any new technology, there is a fear that engagement will decrease over time,” Schoelwer said. “In a research study, the participant has frequent check-ins with the study team, but in the real-world, there presumably is less support. As such, it is reassuring to see that the gains achieved on automated insulin delivery persisted in this large cohort of children at 3 months.”
The number of manual correction boluses decreased from 2.2 per day with the low-glucose suspend system to 1.2 per day at both time points with automated insulin delivery. No change was observed in the number of carbohydrate boluses needed. Total daily insulin increased from 31.6 U per day with the low-glucose suspend system to 34.4 U per day at 1 month and 44.5 U per day at 3 months with automated insulin delivery. The total insulin increase was mostly due to an increase in basal insulin.
Despite the improvements in glucose metrics, Schoelwer said, many children using automated insulin delivery are still unable to meet glycemic targets and further optimization of the systems is needed to achieve better outcomes.
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Schoelwer M, et al. OP 038. Presented at: International Conference on Advanced Technologies & Treatments for Diabetes; Feb. 22-25, 2023; Berlin (hybrid meeting).
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