Switching to an advanced hybrid closed-loop system in real-world practice improves hypoglycemia awareness and metabolic control in adults with type 1 diabetes, particularly in those with impaired perception of hypoglycemia symptoms

Nattero‐Chávez, Lía; Pascual, Edurne Lecumberri; Calle, Esther De La; Cebada, A. Bayona; Ruíz, Teresa; Tobar, Alejandra Quintero; Lorenzo, M. N.; Sánchez, Cristina; Izquierdo, Ana Navas; Luque‐Ramírez, Manuel; Escobar‐Morreale, Héctor F.

doi:10.1016/j.diabres.2023.110627

Cited by 6 publications

(6 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The most advanced technology for type 1 diabetes is a hybrid closed loop system, delivering insulin automatically in response to a sensor glucose value with additional manual boluses controlled by the user for meals, snacks and corrections. Real world data suggest that a hybrid closed loop system may be able to improve hypoglycaemia awareness but in younger adults 4 . Randomised controlled data did not find the same and again this study was in younger adults 5 when the greater prevalence, and risk, from severe hypoglycaemia may be in the again type 1 diabetes population.…”

mentioning

confidence: 62%

Maintaining awareness

Oliver

2023

Diabet Med

View full text Add to dashboard Cite

mentioning

confidence: 62%

Maintaining awareness

Oliver

2023

Diabet Med

View full text Add to dashboard Cite

“…In contrast to the Burckhardt study, Flatt et al (2023), found that both awareness and counterregulatory response improved after the implementation of AID (although this study lacked a control group) ( Hu et al, 2023 ). Another study examined CGM metrics and awareness after the implementation of an advanced AID, MiniMed 780G™ (Medtronic, Dublin, Ireland): multiple daily insulin system ( Nattero-Chávez et al, 2023 ). Out of the 46 patients included in the study, 12 patients (27%) had IAH at the baseline screen based on Clarke scores.…”

Section: Impaired Awareness Of Hypoglycemia (Iah) Therapiesmentioning

confidence: 99%

“…Regardless of previous technology, subjects with IAH had improved HbA1c and Clarke scores; however, authors included subjects with Clarke scores ≥3. A score of 3 on the Clarke score is borderline for IAH; therefore, some aware subjects could have been included in the statistical analysis in the described study ( Nattero-Chávez et al, 2023 ). Additionally, diabetes education provided to the AID subjects could have, independently, played a role in improving awareness scores ( Nattero-Chávez et al, 2023 ).…”

Section: Impaired Awareness Of Hypoglycemia (Iah) Therapiesmentioning

confidence: 99%

Current and future therapies to treat impaired awareness of hypoglycemia

Macon,

Devore,

Lin

et al. 2023

Front. Pharmacol.

View full text Add to dashboard Cite

In order to achieve optimal glycemic control, intensive insulin regimes are needed for individuals with Type 1 Diabetes (T1D) and insulin-dependent Type 2 Diabetes (T2D). Unfortunately, intensive glycemic control often results in insulin-induced hypoglycemia. Moreover, recurrent episodes of hypoglycemia result in both the loss of the characteristic warning symptoms associated with hypoglycemia and an attenuated counterregulatory hormone responses. The blunting of warning symptoms is known as impaired awareness of hypoglycemia (IAH). Together, IAH and the loss of the hormonal response is termed hypoglycemia associated autonomic failure (HAAF). IAH is prevalent in up to 25% in people with T1D and up to 10% in people with T2D. IAH and HAAF increase the risk of severe hypoglycemia 6-fold and 25-fold, respectively. To reduce this risk for severe hypoglycemia, multiple different therapeutic approaches are being explored that could improve awareness of hypoglycemia. Current therapies to improve awareness of hypoglycemia include patient education and psychoeducation, the use of novel glycemic control technology, pancreas/islet transplantation, and drug therapy. This review examines both existing therapies and potential therapies that are in pre-clinical testing. Novel treatments that improve awareness of hypoglycemia, via improving the counterregulatory hormone responses or improving hypoglycemic symptom recognition, would also shed light on the possible neurological mechanisms that lead to the development of IAH. To reduce the risk of severe hypoglycemia in people with diabetes, elucidating the mechanism behind IAH, as well as developing targeted therapies is currently an unmet need for those that suffer from IAH.

show abstract

“…Indeed, in those with impaired awareness of hypoglycemia, despite using a form of diabetes technology (isCGM/CSII or sensor-augmented pump), the use of MM780G led to both improvement of hypoglycemia awareness and HbA1c levels. 25 The benefit of automated insulin delivery systems notwithstanding, access to these systems remains limited in many parts of the world. This is particularly pertinent in countries where there are limited reimbursement policies for those living with diabetes, with all costs for devices borne by the person with T1D.…”

Section: Introductionmentioning

confidence: 99%

The Cost-Effectiveness of an Advanced Hybrid Closed-Loop System Compared to Standard Management of Type 1 Diabetes in a Singapore Setting

Gardner,

Lakkad,

Qiu

et al. 2024

Diabetes Technology & Therapeutics

View full text Add to dashboard Cite

Background: Despite advances in technology, glycemic outcomes in people with type 1 diabetes (T1D) remain suboptimal. The MiniMed 780G (MM780G) advanced hybrid closed-loop (AHCL) system is the latest technology for T1D management with established safety and efficacy. This study explores the cost-effectiveness of MM780G AHCL compared against multiple daily injections (MDI) plus intermittently scanned continuous glucose monitor (isCGM). Methods: A cost-utility analysis was conducted, simulating lifetime outcomes for 1000 T1D individuals, with baseline hemoglobin A1c of 8.4%, using the IQVIA Core Diabetes Model (CDM) v9.5. A Singapore health care payer perspective was taken with 2023 costs applied. Treatment effects were taken from the ADAPT study and treatment-related events from a combination of sources. T1D complication costs were derived from local literature, and health state utilities and disutilities from published literature. Scenario analyses and probabilistic sensitivity analyses (PSAs) explored uncertainty. Cost-effectiveness was assessed based on willingness-to-pay (WTP) thresholds set to Singapore Dollars (SGD) 45,000 (United States Dollars [USD] 33,087) per quality-adjusted life year (QALY) and Singapore's gross domestic product (GDP) per capita of SGD 114,165 (USD 83,941) per QALY. Results: A switch from MDI plus isCGM to MM780G resulted in expected gains in life-years (+0.78) and QALYs (+1.45). Cost savings through reduction in T1D complications (SGD 25,465; USD 18,723) partially offset the higher treatment costs in the AHCL arm (+SGD 74,538; +USD 54,805), resulting in an estimated incremental cost-effectiveness ratio of SGD 33,797 (USD 24,850) per QALY gained. Findings were robust, with PSA outputs indicating 81% and 99% probabilities of cost-effectiveness at the stated WTP thresholds. Conclusion: MM780G is a cost-effective option for people with T1D managed in a Singapore setting.

show abstract

Switching to an advanced hybrid closed-loop system in real-world practice improves hypoglycemia awareness and metabolic control in adults with type 1 diabetes, particularly in those with impaired perception of hypoglycemia symptoms

Cited by 6 publications

References 29 publications

Maintaining awareness

Maintaining awareness

Current and future therapies to treat impaired awareness of hypoglycemia

The Cost-Effectiveness of an Advanced Hybrid Closed-Loop System Compared to Standard Management of Type 1 Diabetes in a Singapore Setting

Contact Info

Product

Resources

About