Real‐world performance of hybrid closed loop in youth, young adults, adults and older adults with type 1 diabetes: Identifying a clinical target for hybrid closed‐loop use

Abstract

Aim To describe real‐world hybrid closed loop (HCL) use and glycaemic outcomes across the lifespan and identify a clinical threshold for HCL use associated with meeting the internationally recommended target of 70% sensor glucose time in range (TIR; 70‐180 mg/dL). Materials and Methods Mixed models examined MiniMed 670G HCL use and glycaemic outcomes in 276 people with type 1 diabetes from four age groups: youth (aged <18 years), young adults (18‐25 years), adults (26‐49 years) and older adults (≥50 years) for 1 year. ROC analysis identified the minimum percentage HCL use associated with meeting the TIR goal of 70%. Results HCL use at month 1 was 70.7% ± 2.9% for youth, 71.0% ± 3.8% for young adults, 78.9% ± 2.1% for adults and 84.7% ± 3.8% in older adults. HCL use declined significantly at 12 months to 49.3% ± 3.2% in youth (P < .001) and 55.7% ± 4.3% in young adults (P = .002). HCL use was sustained at 12 months in adults (76.4% ± 2.2%, P = .36) and older adults (80.4% ± 3.9%, P = .36). HCL use of 70.6% was associated with 70% TIR (sensitivity 58.3%, specificity 85%, AUC 0.77). Older age, 80% or higher continuous glucose monitor use and four or more blood glucose checks per day were associated with attaining the HCL‐use threshold. Conclusions HCL use of 70% or higher may be a useful target for clinicians to use to assist people with diabetes in attaining glycaemic goals. Youth may struggle with HCL use more than adults and require clinical intervention to help sustain HCL use across time.

Safety, metabolic and psychological outcomes of Medtronic MiniMed 670G in children, adolescents and young adults: a systematic review

“…A reduction about the use of CGM in real world was confirmed in 115 patients younger than 25 years. Its use decreased from 71% at month 1 to 49–55% at month 12, and the TIR from 60.4–63.3% to 53.6–61.3% [ 13 ].…”

Hybrid closed-loop glucose control compared with sensor augmented pump therapy in older adults with type 1 diabetes: an open-label multicentre, multinational, randomised, crossover study

“…17 Use of the closed-loop system was associated with high scores in ease of use, trust, and usability. In a real-world analysis of 33 older adults (aged ≥50 years) using the Medtronic 670G closed-loop system, time in target glucose range was between 73% and 75% during 12 months of follow-up, 18 whereas in a retrospective analysis of 48 older adults (aged ≥65 years) using Control IQ, time in range 0000 h 0200 h 0400 h 0600 h 0800 h 1000 h 1200 h 1400 h 1600 h 1800 h 2000 h 2200 h 2359 h Table 3: Adverse events and safety analyses in the intention-to-treat analysis population was 76% over 3 months of follow-up. 19 Assessment of the efficacy and safety of hybrid closed-loop system from these studies is limited by their design.…”

Continuous Glucose Monitor, Insulin Pump, and Automated Insulin Delivery Therapies for Type 1 Diabetes: An Update on Potential for Cardiovascular Benefits

“…The 670G system was subsequently approved in children with an average TIR of 65% and the updated 770G system later received approval in young children with an average TIR of 63.8% [74,75]. While the 670G and 770G systems brought HCL technology from research to realworld use, the systems were limited by frequent fingerstick testing requirements, excessive system alerts, and frequent exits from automation [76][77][78][79]. A 12-month analysis of realworld use of the Medtronic 670G at a single center found a significant decrease in time spent in HCL mode over time, with a decrease from 70.7% at 1 month of use to 49.3% at 12 months of use in children with T1D [77].…”

“…While the 670G and 770G systems brought HCL technology from research to realworld use, the systems were limited by frequent fingerstick testing requirements, excessive system alerts, and frequent exits from automation [76][77][78][79]. A 12-month analysis of realworld use of the Medtronic 670G at a single center found a significant decrease in time spent in HCL mode over time, with a decrease from 70.7% at 1 month of use to 49.3% at 12 months of use in children with T1D [77]. This same analysis demonstrated showed that adults had a higher time in HCL mode which was maintained in the 78-76% range over 12 months.…”