Hybrid Closed-loop to Manage Gastroparesis in People With Type 1 Diabetes: a Case Series

Abstract

Background: Gastroparesis is associated with unpredictable gastric emptying and can lead to erratic glucose profiles and negative impacts on quality-of-life. Many people with gastroparesis are unable to meet glycemic targets and there is a need for new approaches for this population. Hybrid closed-loop systems improve glucose control and quality-of-life but evidence for their use in people with diabetic gastroparesis is limited. Methods: We present a narrative review of the challenges associated with type 1 diabetes management for people with gastroparesis and present a case series of 7 people with type 1 diabetes and gastroparesis. We compare glycemic control before and during the first 12 months of hybrid closed-loop therapy. Data were analyzed using electronic patient records and glucose management platforms. We also discuss future advancements for closed-loop systems that may benefit this population. Results: Five of 7 patients had data available for time in range before and during hybrid closed-loop therapy, and all had an improvement in percentage time in target glucose range, with the overall mean time in range increasing from 26.0% ± 15.7% to 58.4% ± 8.6% during HCL use, ( P = .004). There were significant reductions in HbA1c (83 ± 9 mmol/mol to 71 ± 14 mmol/mol) and mean glucose from 13.0 ± 1.7 mmol/L (234 ± 31 mg/dL) to 10.0 ± 0.7 mmol/L (180 ± 13 mg/dL) with use of a hybrid closed-loop system. Importantly, this was achieved without an increase in time in hypoglycemia ( P = .50). Conclusion: Hybrid closed-loop systems may represent a valuable approach to improve glycemic control for people with type 1 diabetes and gastroparesis. Prospective studies are required to confirm these findings.

Underutilisation of gastric emptying studies and underrecognition of gastroparesis in people with diabetes treated in a hospital setting

“…The patients in our study had a suboptimal HbA1c (8.7% ± 2.0), which may be targeted for intervention and subsequent improvement of gastroparesis symptoms. Recent studies of hybrid closed loop in patients with type 1 diabetes and gastroparesis have been promising 19 …”

“…Recent studies of hybrid closed loop in patients with type 1 diabetes and gastroparesis have been promising. 19 We identified significant, underrecognised malnutrition in this group, and only half were assessed by a dietitian. Nutrition is a pillar of gastroparesis management, and suspicion of gastroparesis should prompt a dietitian referral.…”

Gastroparesis in Adolescent Patient with Type 1 Diabetes: Severe Presentation of a Rare Pediatric Complication

“…In the presented case, we decided to start continuous subcutaneous insulin infusion therapy with an aHCL system. Two studies have already demonstrated the efficacy of HCL systems in adults with T1D and gastroparesis ( 26 , 27 ). In particular, Daly et al ( 26 ) recently reported significant reductions in HbA1c and mean glucose in five patients over one year of HCL use, while Kaur et al ( 27 ) had previously shown that HCL had similar effectiveness and safety in adults with T1D and gastroparesis compared to age, sex, and diabetes duration controls.…”

Normal and disordered gastric emptying in diabetes: recent insights into (patho)physiology, management and impact on glycaemic control

“…The effect of improvement in chronic glycaemic control (HbA 1c ) remains uncertain with an absence of controlled studies, although a prospective study reported normalisation of delayed gastric emptying, measured with scintigraphy, following improved glycaemic control [ 66 ]. A small trial in individuals with type 1 diabetes and gastroparesis found that hybrid closed loop insulin pump therapy improved the mean percentage time that blood glucose was in range (3.9–10 mmol/l) from 26% to 58.4%, however neither gastrointestinal symptoms nor gastric emptying were evaluated [ 67 ]. Nutritional support (e.g.…”