Advanced hybrid closed-loop therapy reduces HbA1c for adolescents with type 1 diabetes
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Key takeaways:
- Teens and young adults with type 1 diabetes who switched to hybrid closed-loop insulin delivery reduced their HbA1c by 2.9 percentage points at 3 months.
- Time in range more than doubled.
Advanced hybrid closed-loop therapy reduces HbA1c and improves time in range among adolescents and young adults with type 1 diabetes, with few serious adverse events, according to findings published in Diabetes Care.
In data from a small cohort of 20 teenagers and young adults with type 1 diabetes and a baseline HbA1c of 8.5% or higher, use of advanced hybrid closed-loop system reduced mean HbA1c by 2.9 percentage points at 3 months and time in range more than doubled from 27.6% at baseline to 66.5% at 3 months.
“Advanced automated insulin delivery for these young people struggling with their diabetes management was life-changing for many,” Ben Wheeler, MBCHB, DCH, CCE, FRACP, PhD, pediatric endocrinologist in the department of women’s and children’s health at the University of Otago and at Te Whatu Ora – Health in Dunedin, New Zealand, told Healio. “The glycemic improvements were very impressive, the largest currently documented for a study examining automated insulin delivery.”
Wheeler and colleagues conducted a prospective, single-arm, dual-center study in which 20 adolescents and young adults aged 13 to 25 years who had an HbA1c of at least 8.5% and were on multiple daily insulin injection therapy at baseline were recruited from public hospitals in Dunedin and Christchurch in New Zealand. Baseline data were collected for 2 weeks using a masked continuous glucose monitor. After the 2-week period ended, participants used the Medtronic MiniMed 780G for 3 months. Primary outcomes were the change in time in range between 70 mg/dL and 180 mg/dL and HbA1c from baseline to the end of the intervention. Secondary outcomes included sensor glucose, coefficient of variation and device usage parameters. Serious adverse events were defined as severe hypoglycemia and diabetic ketoacidosis.
The cohort had a mean decrease in HbA1c from 10.5% at baseline to 7.6% at 3 months. Time in range increased from 27.6% at baseline to 66.5% at 3 months. Sensor glucose dropped from 246 mg/dL at baseline to 163 mg/dL at follow-up and coefficient of variation declined from 38.9% to 34.6%.
Participants had the device’s SmartGuard feature active for 91% of the time of the study. Sensors were worn for 86.5% of the study. Mean insulin total daily dose was 72.1 U, of which 47.1% were automatically administered. Of the remaining bolus insulin, 51.2% were administered through autocorrection.
“One of the most interesting findings was that, on average, 74% of all daily insulin was automatically delivered by the advanced hybrid closed-loop system,” Wheeler said. “For people living with diabetes and helping treat people with diabetes, these findings highlight the growing power of automated insulin delivery, and we are very much looking forward to seeing how this technology improves into the future.”
There were no cases of severe hypoglycemia reported. Two participants had an episode of mild to moderate DKA, which researchers attributed to infusion set occlusion.
Wheeler said his research team is beginning to conduct a multisite, national randomized controlled trial to try and confirm this study’s findings in a larger cohort.
“We hope that this will ensure automated insulin delivery will be clearly confirmed as the gold standard of therapy both for those in target with their diabetes therapy but also those struggling to manage their diabetes with traditional therapies,” Wheeler said. “We strongly feel that those struggling with diabetes management and experiencing the most burden have in fact the most to gain from automated diabetes technology.”
For more information:
Benjamin J. Wheeler, MBCHB, DCH, CCE, FRACP, PhD, can be reached at ben.wheeler@otago.ac.nz.
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