Impact of Advanced Hybrid Closed Loop on Youth With High-Risk Type 1 Diabetes Using Multiple Daily Injections

Abstract

OBJECTIVE To evaluate glycemic outcomes in youth (aged 13–25 years) with type 1 diabetes and high-risk glycemic control (HbA1c ≥8.5% [69 mmol/mol]) on multiple daily injection (MDI) therapy after transitioning to advanced hybrid closed loop (AHCL) therapy. RESEARCH DESIGN AND METHODS This prospective, 3-month, single-arm, dual-center study enrolled 20 participants, and all completed the study. RESULTS HbA1c decreased from 10.5 ± 2.1% (91.2 ± 22.8 mmol/mol) at baseline to 7.6 ± 1.1% (59.7 ± 11.9 mmol/mol), and time spent in target range 70–180 mg/dL (3.9–10.0 mmol/L) increased from 27.6 ± 13.2% at baseline to 66.5 ± 9.8% after 3 months of AHCL. Two episodes of diabetic ketoacidosis attributed to infusion set failure occurred. CONCLUSIONS AHCL has the potential to improve suboptimal glycemia in youth with type 1 diabetes previously on MDI therapy.

Turning the tides: achieving rapid and safe glucose control in adolescents with suboptimally controlled type 1 diabetes using advanced hybrid closed loop systems

“…The findings of the present case series align with previous studies using other advanced automated insulin delivery systems ( 5 – 8 ). This consistency of findings underscores the robustness of the AHCL algorithm and supports the application of closed-loop systems across a broad range of individuals with T1D.…”

Safety, Metabolic and Psychological Outcomes of Medtronic MiniMed 780G™ in Children, Adolescents and Young Adults: A Systematic Review

“…Uncontrolled trials confirmed these data. TBR was shown to always remain at target, with a TIR improvement of approximately 10% in people living with diabetes who were on the PLGM system before using AHCL [ 20 , 21 , 26 ], and an even larger improvement of approximately 35–40% in those using MDI therapy before AHCL [ 24 , 25 ].…”

“…Similar to the MiniMed™ 670G system, the 780G system proved to be safe in regard to the prevention of severe hypoglycaemia. No episodes were reported under any study condition, including an experimental setting with a late meal bolus [ 20 ] or flex vs fixed carbohydrate counting [ 27 ], a randomized clinical trial in a free-living setting [ 19 ], a single-arm study with a home setting [ 21 , 24 , 25 , 31 , 34 , 36 ], prolonged fasting due to Ramadan [ 28 ], and even when tested in preschool children [ 26 ]. The study by Tornese et al [ 52 ], which included 12 preschool children and was published after the literature search for this review, confirmed that the MiniMed 780G™ system may be safe and effective even in children < 7 years of age and with a total daily dose < 8 IU.…”

“…All participants greatly improved their glycaemic control, as indicated by HbA1c, TIR and TAR ( p < 0.001). The mean SG and CV were also lower after 3 months of AHCL therapy [ 25 ].…”

“…No SH episodes occurred after 3 months of AHCL use among adolescents and young adults with high-risk glycaemic control who previously underwent MDI therapy [ 25 ]. Two episodes of mild-to-moderate DKA occurred, both due to infusion set failure/occlusion and poor experience with CSII therapy.…”