Closed-loop systems linked to higher time in range for children with type 1 diabetes
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Key takeaways:
- The use of closed-loop insulin delivery conferred a 10.99% higher time in range than standard of care for pediatric type 1 diabetes.
- No difference was observed between the two groups for overall hypoglycemia.
CHICAGO — Children with type 1 diabetes using closed-loop insulin delivery systems spend more time in range than those receiving insulin injections or using a sensor-augmented pump or continuous glucose monitor, according to study data.
“Several studies and meta-analyses have reported encouraging results on the effectiveness of these [closed-loop] devices,” Amanda Godoi, a fourth-year medical student at the Cardiff University School of Medicine in the U.K., said during a press conference at ENDO 2023. “These assessments have only focused on variable timing, mostly hours and days, which limits the pragmatic application of the use of closed-loop systems for these patients, who are usually in an outpatient setting where conditions are unpredictable and these patients are having to continuously use these devices. So we aimed to perform a systematic review and meta-analysis of randomized controlled trials comparing automated insulin delivery to usual care for children with type 1 diabetes.”
Researchers searched the PubMed, Cochrane and Embase databases in October 2022. Closed-loop systems included automated pancreas, hybrid closed-loop and advanced hybrid closed-loop. Standard of care included multiple daily insulin injections, sensor-augmented insulin pump, predictive low-glucose suspend and CGM. Trials at least 12 weeks in duration were included. Time in glucose range between 70 mg/dL and 180 mg/dL, change in HbA1c and time in hypoglycemia with a glucose of less than 70 mg/dL were analyzed.
There were 12 randomized controlled trials with 993 children with type 1 diabetes included. The duration of the trials ranged from 12 to 96 weeks.
Children using a closed-loop system had a higher time in range compared with those receiving standard of care (mean difference, 10.99%; P < .001). Use of a closed-loop system was associated with a lower HbA1c compared with standard of care (mean difference, –0.37%). No difference was observed in time spent in hypoglycemia, though the closed-loop group spent less time in nocturnal hypoglycemia than the standard of care group (P < .002). Closed-loop therapy was also associated with a lower time above range of greater than 180 mg/dL and greater than 250 mg/dL than standard of care (P < .001 for both).
Godoi said the results of the meta-analysis were similar regardless of baseline HbA1c or the follow-up duration of the studies.
“We speculate that these findings have important implications for future randomized trials exploring the effects of bihormonal and fully closed-loop systems that will place focus on patient education and also device functioning and the type of machine used,” Godoi said.
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Hespanhol LC, et al. SAT-093. Presented at: ENDO annual meeting; June 15-18, 2023; Chicago.
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