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Significant Improvement in Glycemic Control after Initiation of AHCL in Children with Type 1 Diabetes: A Single Center Prospective Study
Affiliations- Department of Pediatric Endocrinology and Diabetes, Koç University Hospital, Istanbul, Turkey
- Koç University School of Medicine, Istanbul, Turkey
open access
Abstract
Objective: This study aims to investigate the early impact of advanced hybrid closed loop system (AHCL) in achieving and maintaining treatment goals in children with T1D. Materials and methods: A prospective longitudinal study was designed. Two separate analyzes were performed. The first one included the comparison of two systems in children with T1D who used to have Medtronic 640G system, then upgraded to the AHCL system, while the second analysis included the first 3 month-period analysis of glycemic parameters of children using AHCL, regardless their previous treatment before AHCL. Change in time in range (TIR) and a glucose management indicator (GMI) were compared at 3-month from baseline using t-test and Mann-Whitney U-test based on normality of the data. Results: The cohort-1 included the children (n = 25, age: 10.5 ± 2.5 years) who were transitioned from Medtronic 640G to AHCL. TIR (3.8–10 mmol/L) increased from 75.5 ± 10% at baseline to 80 ± 6.2% at 3 months (p = 0.008). The cohort-2 included 33 children (age: 12.1 ± 3.2 years) and a total of 2970 patient-days were analyzed. The mean TIR (3.8–10 mmol/L), was 79.8 ± 8.1%. The mean GMI was 6.6 ± 0.3%. The frequency of participants who had a GMI < 7%, time below range (TBR < 3.8 mmol/L) < 4% were 84.8% and 100%, respectively. The fraction of those who achieved the 3 glycemic targets (GMI < 7% and TIR > 70% and TBR < 4%) was 81.8%. Conclusions: This is the first study to report the positive impact of AHCL on the glycemic metrics of children with T1D from Turkey. Almost all children using AHCL have achieved glycemic targets and it is possible to achieve percentage of TIR which exceeds 80% with this system.
Abstract
Objective: This study aims to investigate the early impact of advanced hybrid closed loop system (AHCL) in achieving and maintaining treatment goals in children with T1D. Materials and methods: A prospective longitudinal study was designed. Two separate analyzes were performed. The first one included the comparison of two systems in children with T1D who used to have Medtronic 640G system, then upgraded to the AHCL system, while the second analysis included the first 3 month-period analysis of glycemic parameters of children using AHCL, regardless their previous treatment before AHCL. Change in time in range (TIR) and a glucose management indicator (GMI) were compared at 3-month from baseline using t-test and Mann-Whitney U-test based on normality of the data. Results: The cohort-1 included the children (n = 25, age: 10.5 ± 2.5 years) who were transitioned from Medtronic 640G to AHCL. TIR (3.8–10 mmol/L) increased from 75.5 ± 10% at baseline to 80 ± 6.2% at 3 months (p = 0.008). The cohort-2 included 33 children (age: 12.1 ± 3.2 years) and a total of 2970 patient-days were analyzed. The mean TIR (3.8–10 mmol/L), was 79.8 ± 8.1%. The mean GMI was 6.6 ± 0.3%. The frequency of participants who had a GMI < 7%, time below range (TBR < 3.8 mmol/L) < 4% were 84.8% and 100%, respectively. The fraction of those who achieved the 3 glycemic targets (GMI < 7% and TIR > 70% and TBR < 4%) was 81.8%. Conclusions: This is the first study to report the positive impact of AHCL on the glycemic metrics of children with T1D from Turkey. Almost all children using AHCL have achieved glycemic targets and it is possible to achieve percentage of TIR which exceeds 80% with this system.
Keywords
children, type 1 diabetes, 780 g, advanced hybrid closed loop, time in range
About this articleTitle
Significant Improvement in Glycemic Control after Initiation of AHCL in Children with Type 1 Diabetes: A Single Center Prospective Study
Journal
Issue
Article type
Research paper
Pages
45-52
Published online
2023-01-26
Page views
1155
Article views/downloads
82
DOI
10.5603/DK.a2022.0063
Bibliographic record
CD 2023;12(1):45-52.
Keywords
children
type 1 diabetes
780 g
advanced hybrid closed loop
time in range
Authors
Gül Yeşiltepe Mutlu
Elif Eviz
Ecem Can
Tugba Gokce
Serra Muradoglu
Sukru Hatun
References (26)- Lewis DM. Do-it-yourself artificial pancreas system and the OpenAPS movement. Endocrinol Metab Clin North Am. 2020; 49(1): 203–213.
- Shah VN, DuBose SN, Li Z, et al. Continuous glucose monitoring profiles in healthy nondiabetic participants: a multicenter prospective study. J Clin Endocrinol Metab. 2019; 104(10): 4356–4364.
- Battelino T, Danne T, Bergenstal R, et al. Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range. Diabetes Care. 2019; 42(8): 1593–1603.
- Commissariat PV, Harrington KR, Whitehouse AL, et al. "I'm essentially his pancreas": Parent perceptions of diabetes burden and opportunities to reduce burden in the care of children <8 years old with type 1 diabetes. Pediatr Diabetes. 2020; 21(2): 377–383.
- Foster NC, Beck RW, Miller KM, et al. State of type 1 diabetes management and outcomes from the T1D exchange in 2016-2018. Diabetes Technol Ther. 2019; 21(2): 66–72.
- Redondo MJ, Libman I, Maahs DM, et al. The evolution of hemoglobin A1c targets for youth with type 1 diabetes: rationale and supporting evidence. Diabetes Care. 2021; 44(2): 301–312.
- Corathers SD, DeSalvo DJ. Therapeutic inertia in pediatric diabetes: challenges to and strategies for overcoming acceptance of the status quo. Diabetes Spectr. 2020; 33(1): 22–30.
- Johnson SR, Cooper MN, Davis EA, et al. Hypoglycaemia, fear of hypoglycaemia and quality of life in children with Type 1 diabetes and their parents. Diabet Med. 2013; 30(9): 1126–1131.
- Cengiz E. Automated Insulin Delivery in Children with Type 1 Diabetes. Endocrinol Metab Clin North Am. 2020; 49(1): 157–166.
- Da Silva J, Lepore G, Battelino T, et al. Real-World performance of the MiniMed™ 780G system: first report of outcomes from 4120 users. Diabetes Technol Ther. 2022; 24(2): 113–119.
- Hatun Ş, Demirbilek H, Darcan Ş, et al. Turkish Pediatric Diabetes Research Group. Evaluation of therapeutics management patterns and glycemic control of pediatric type 1 diabetes mellitus patients in Turkey: A nationwide cross-sectional study. Diabetes Res Clin Pract. 2016; 119: 32–40.
- Addala A, Auzanneau M, Miller K, et al. A decade of disparities in diabetes technology use and hba in pediatric type 1 diabetes: a transatlantic comparison. Diabetes Care. 2021; 44(1): 133–140.
- Walker AF, Hood KK, Gurka MJ, et al. Barriers to technology use and endocrinology care for underserved communities with type 1 diabetes. Diabetes Care. 2021; 44(7): 1480–1490.
- Akturk HK, Agarwal S, Hoffecker L, et al. Inequity in racial-ethnic representation in randomized controlled trials of diabetes technologies in type 1 diabetes: critical need for new standards. Diabetes Care. 2021; 44(6): e121–e123.
- Smart CE, Annan F, Higgins LA, et al. ISPAD Clinical Practice Consensus Guidelines 2018: Nutritional management in children and adolescents with diabetes. Pediatr Diabetes. 2018; 19(27): 136–154.
- Beato-Víbora PI, Gallego-Gamero F, Ambrojo-López A, et al. Rapid improvement in time in range after the implementation of an advanced hybrid closed-loop system in adolescents and adults with type 1 diabetes. Diabetes Technol Ther. 2021; 23(9): 609–615.
- Bergenstal R, Nimri R, Beck R, et al. FLAIR Study Group. A comparison of two hybrid closed-loop systems in adolescents and young adults with type 1 diabetes (FLAIR): a multicentre, randomised, crossover trial. The Lancet. 2021; 397(10270): 208–219.
- Carlson AL, Sherr JL, Shulman DI, et al. Safety and glycemic outcomes during the MiniMed™ advanced hybrid closed-loop system pivotal trial in adolescents and adults with type 1 diabetes. Diabetes Technol Ther. 2022; 24(3): 178–189.
- Collyns OJ, Meier RA, Betts ZL, et al. Improved glycemic outcomes with medtronic MiniMed advanced hybrid closed-loop delivery: results from a randomized crossover trial comparing automated insulin delivery with predictive low glucose suspend in people with type 1 diabetes. Diabetes Care. 2021; 44(4): 969–975.
- Dovc K, Battelino T. Time in range centered diabetes care. Clin Pediatr Endocrinol. 2021; 30(1): 1–10.
- Phillip M, Nimri R, Bergenstal RM, et al. Consensus Recommendations for the Use of Automated Insulin Delivery (AID) Technologies in Clinical Practice. Endocr Rev. 2022 [Epub ahead of print].
- Brown SA, Forlenza GP, Bode BW, et al. Omnipod 5 Research Group. Multicenter trial of a tubeless, on-body automated insulin delivery system with customizable glycemic targets in pediatric and adult participants with type 1 diabetes. Diabetes Care. 2021; 44(7): 1630–1640.
- Isganaitis E, Raghinaru D, Ambler-Osborn L, et al. Closed-loop insulin therapy improves glycemic control in adolescents and young adults: outcomes from the international diabetes closed-loop trial. Diabetes Technology & Therapeutics. 2021; 23(5): 342–349.
- Wheeler BJ, Collyns OJ, Meier RA, et al. Improved technology satisfaction and sleep quality with Medtronic MiniMed® Advanced Hybrid Closed-Loop delivery compared to predictive low glucose suspend in people with Type 1 Diabetes in a randomized crossover trial. Acta Diabetol. 2022; 59(1): 31–37.
- Hood KK, Laffel LM, Danne T, et al. Lived experience of advanced hybrid closed-loop versus hybrid closed-loop: patient-reported outcomes and perspectives. Diabetes Technol Ther. 2021; 23(12): 857–861.
- Desrochers HR, Schultz AT, Laffel LM. Use of diabetes technology in children: role of structured education for young people with diabetes and families. Endocrinol Metab Clin North Am. 2020; 49(1): 19–35.