1
|
Fresa R, Bitterman O, Cavallaro V, Di Filippi M, Dimarzo D, Mosca C, Nappi F, Rispoli M, Napoli A. An automated insulin delivery system from pregestational care to postpartum in women with type 1 diabetes. Preliminary experience with telemedicine in 6 patients. Acta Diabetol 2024:10.1007/s00592-024-02315-z. [PMID: 38849658 DOI: 10.1007/s00592-024-02315-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 05/29/2024] [Indexed: 06/09/2024]
Abstract
INTRODUCTION The use of most commercially available automated insulin delivery (AID) systems is off-label in pregnancy. However, an increasing number of women with type 1 diabetes (T1D) use such devices throughout pregnancy and delivery. We analysed the data of six women with T1D from a single centre (Diabetology Outpatient Clinic of District-63/Asl Salerno, Italy) who were able to start and maintain AID therapy with the MiniMed™ 780G (Medtronic, Minneapolis, MN, USA) throughout the pregestational care period, pregnancy, delivery, and postpartum. METHODS We retrospectively collected data from six patients with T1D who received training and initiation on use of the MiniMed™ 780G and attended follow-up visits throughout pregnancy (these visits were virtual because of the COVID-19 pandemic). All patients maintained their devices in the closed-loop setting throughout pregnancy and during labour and delivery. We analysed data from the pregestational phase to the first 30 days postpartum. RESULTS All patients achieved the recommended metabolic goals before conception [median time in range (TIR) of 88% for 70-180 mg/dL; median pregnancy-specific TIR 63-140 mg/dL (ps-TIR) of 66% and maintained the ps-TIR until delivery (median ps-TIR 83%). All patients had slightly better metrics during the night than during the day, with a very low time below range of < 63 mg/dL. Optimal glycaemic values were also maintained on the day of labour and delivery (median ps-TIR 92.5%) and in the first 30 days postpartum, with no severe hypoglycaemia. The only neonatal complications were jaundice in one child and an interatrial defect in another child. CONCLUSION In our well-selected and trained patients, use of the MiniMed™ 780G helped to achieve and maintain ps-metrics from the pregestational period to delivery despite the fact that the algorithm is not set to achieve the ambitious glycaemic values recommended for pregnancy.
Collapse
Affiliation(s)
- Raffaella Fresa
- Diabetology Outpatient Clinic , Asl Salerno, District 63, Salerno, Italy
| | - Olimpia Bitterman
- Diabetology Unit, San Paolo Hospital, ASL Roma 4, Civitavecchia, Rome, Italy.
| | - Vincenzo Cavallaro
- Diabetology Outpatient Clinic , Asl Salerno, District 63, Salerno, Italy
| | | | - Daniela Dimarzo
- Diabetology Outpatient Clinic , Asl Salerno, District 63, Salerno, Italy
| | - Carmela Mosca
- Diabetology Outpatient Clinic , Asl Salerno, District 63, Salerno, Italy
| | - Francesca Nappi
- Diabetology Outpatient Clinic , Asl Salerno, District 63, Salerno, Italy
| | - Marilena Rispoli
- Diabetology Outpatient Clinic , Asl Salerno, District 63, Salerno, Italy
| | - Angela Napoli
- Israelitico Hospital, Rome, Italy
- International Medical University Unicamillus, Rome, Italy
- Cdc Santa Famiglia, Rome, Italy
| |
Collapse
|
2
|
Sebastian-Valles F, Arranz Martin JA, Martínez-Alfonso J, Jiménez-Díaz J, Hernando Alday I, Navas Moreno V, Armenta Joya T, Fandiño García MDM, Román Gómez GL, Garai Hierro J, Lander Lobariñas LE, Martinez de Icaya P, Sampedro-Nuñez MA, Martínez-Vizcaíno V, Marazuela M. Effect of Christmas Holidays on Type 1 Diabetes Mellitus in Users of Glucose Flash Systems. Endocr Pract 2024; 30:372-379. [PMID: 38307457 DOI: 10.1016/j.eprac.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/19/2024] [Accepted: 01/24/2024] [Indexed: 02/04/2024]
Abstract
OBJECTIVE Christmas holidays can impact weight and glycemic control in type 2 diabetes, but their effect on type 1 diabetes (T1D) remains understudied. This study assessed how Christmas holidays affect individuals with T1D who use flash continuous glucose monitoring systems. METHODS This retrospective study involved 812 adults diagnosed with T1D recruited from 3 hospitals. Clinical, anthropometric, and socioeconomic data were collected. Glucose metrics from 14 days before January 1st, and before December 1st and February 1st as control periods, were recorded. Analyses adjusted for multiple variables were conducted to assess the holiday season's impact on glycemic control. RESULTS The average time in range during the holidays (60.0 ± 17.2%) was lower compared to December (61.9 ± 17.2%, P < .001) and February (61.7 ± 17.7%, P < .001). Time above range (TAR > 180 mg/dL) was higher during Christmas (35.8 ± 18.2%) compared to December (34.1 ± 18.3%, P < .001) and February (34.2 ± 18.4%, P < .001). Differences were also observed in TAR >250 mg/dL, coefficient of variation, and average glucose (P < .05). No differences were found in time below range or other metrics. Linear regression models showed that the holidays reduced time in range by 1.9% (β = -1.92, P = .005) and increased TAR >180 mg/dL by 1.8% (β = 1.75, P = .016). CONCLUSION Christmas holidays are associated with a mild and reversible deterioration in glucose metrics among individuals with T1D using flash continuous glucose monitoring, irrespective of additional influencing factors. These discoveries can be useful to advise individuals with diabetes during the festive season and to recognize potential biases within studies conducted during this timeframe.
Collapse
Affiliation(s)
- Fernando Sebastian-Valles
- Department of Endocrinology and Nutrition, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, Madrid, Spain.
| | - Jose A Arranz Martin
- Department of Endocrinology and Nutrition, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Julia Martínez-Alfonso
- Department of Family and Community Medicine, Hospital La Princesa/Centro de Salud Daroca, Madrid, Spain
| | - Jessica Jiménez-Díaz
- Department of Endocrinology and Nutrition, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
| | - Iñigo Hernando Alday
- Department of Endocrinology and Nutrition, Hospital Universitario Basurto, Bilbao, Spain
| | - Victor Navas Moreno
- Department of Endocrinology and Nutrition, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Teresa Armenta Joya
- Department of Endocrinology and Nutrition, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Gisela L Román Gómez
- Department of Endocrinology and Nutrition, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
| | - Jon Garai Hierro
- Department of Endocrinology and Nutrition, Hospital Universitario Basurto, Bilbao, Spain
| | - Luis E Lander Lobariñas
- Department of Endocrinology and Nutrition, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
| | | | - Miguel A Sampedro-Nuñez
- Department of Endocrinology and Nutrition, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Vicente Martínez-Vizcaíno
- Health and Social Care Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain; Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Mónica Marazuela
- Department of Endocrinology and Nutrition, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| |
Collapse
|
3
|
Nigi L, Iraci Sareri G, Cataldo D, Dotta F. 12-Month Efficacy of Advanced Hybrid Closed-Loop System in Adult Type 1 Diabetes Patients. Diabetes Technol Ther 2024; 26:130-135. [PMID: 37902713 DOI: 10.1089/dia.2023.0319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Automated insulin delivery (AID) systems have improved glycemic control in individuals with type 1 diabetes (T1D). The "advanced hybrid closed loop" (AHCL) stands out as the most recent development in AID systems for T1D management. In a real-world clinical environment, we retrospectively evaluated the AHCL MiniMed™ 780G system's effectiveness to achieve and sustain glycemic control over a 12-month period in 22 adult T1D subjects. Within just 14 days of activating the automatic mode, the AHCL MiniMed 780G system showed rapid improvement in glycemic control, which persisted for 12 months. These findings underscore the effectiveness of AHCL systems in achieving and preserving optimal glycemic control in adults with T1D over a very long follow-up.
Collapse
Affiliation(s)
- Laura Nigi
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
- Diabetes and Metabolic Diseases Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Gabriele Iraci Sareri
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Dorica Cataldo
- Diabetes and Metabolic Diseases Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Francesco Dotta
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
- Diabetes and Metabolic Diseases Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| |
Collapse
|
4
|
Guerlich K, Patro-Golab B, Dworakowski P, Fraser AG, Kammermeier M, Melvin T, Koletzko B. Evidence from clinical trials on high-risk medical devices in children: a scoping review. Pediatr Res 2024; 95:615-624. [PMID: 37758865 PMCID: PMC10899114 DOI: 10.1038/s41390-023-02819-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/31/2023] [Accepted: 09/03/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Meeting increased regulatory requirements for clinical evaluation of medical devices marketed in Europe in accordance with the Medical Device Regulation (EU 2017/745) is challenging, particularly for high-risk devices used in children. METHODS Within the CORE-MD project, we performed a scoping review on evidence from clinical trials investigating high-risk paediatric medical devices used in paediatric cardiology, diabetology, orthopaedics and surgery, in patients aged 0-21 years. We searched Medline and Embase from 1st January 2017 to 9th November 2022. RESULTS From 1692 records screened, 99 trials were included. Most were multicentre studies performed in North America and Europe that mainly had evaluated medical devices from the specialty of diabetology. Most had enrolled adolescents and 39% of trials included both children and adults. Randomized controlled trials accounted for 38% of the sample. Other frequently used designs were before-after studies (21%) and crossover trials (20%). Included trials were mainly small, with a sample size <100 participants in 64% of the studies. Most frequently assessed outcomes were efficacy and effectiveness as well as safety. CONCLUSION Within the assessed sample, clinical trials on high-risk medical devices in children were of various designs, often lacked a concurrent control group, and recruited few infants and young children. IMPACT In the assessed sample, clinical trials on high-risk medical devices in children were mainly small, with variable study designs (often without concurrent control), and they mostly enrolled adolescents. We provide a systematic summary of methodologies applied in clinical trials of medical devices in the paediatric population, reflecting obstacles in this research area that make it challenging to conduct adequately powered randomized controlled trials. In view of changing European regulations and related concerns about shortages of high-risk medical devices for children, our findings may assist competent authorities in setting realistic requirements for the evidence level to support device conformity certification.
Collapse
Affiliation(s)
- Kathrin Guerlich
- LMU-Ludwig Maximilians Universität Munich, Division of Metabolic and Nutritional Medicine, Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, Munich, Germany
- Child Health Foundation - Stiftung Kindergesundheit, c/o Dr. von Hauner Children's Hospital, Munich, Germany
| | - Bernadeta Patro-Golab
- LMU-Ludwig Maximilians Universität Munich, Division of Metabolic and Nutritional Medicine, Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, Munich, Germany
| | | | - Alan G Fraser
- Department of Cardiology, University Hospital of Wales, Cardiff, Wales, UK
| | - Michael Kammermeier
- LMU-Ludwig Maximilians Universität Munich, Division of Metabolic and Nutritional Medicine, Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, Munich, Germany
| | - Tom Melvin
- Department of Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Berthold Koletzko
- LMU-Ludwig Maximilians Universität Munich, Division of Metabolic and Nutritional Medicine, Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, Munich, Germany.
- Child Health Foundation - Stiftung Kindergesundheit, c/o Dr. von Hauner Children's Hospital, Munich, Germany.
- European Academy of Paediatrics, Brussels, Belgium.
| |
Collapse
|
5
|
Beato-Víbora PI, Chico A, Moreno-Fernandez J, Bellido-Castañeda V, Nattero-Chávez L, Picón-César MJ, Martínez-Brocca MA, Giménez-Álvarez M, Aguilera-Hurtado E, Climent-Biescas E, Azriel-Mir S, Rebollo-Román Á, Yoldi-Vergara C, Pazos-Couselo M, Alonso-Carril N, Quirós C. A Multicenter Prospective Evaluation of the Benefits of Two Advanced Hybrid Closed-Loop Systems in Glucose Control and Patient-Reported Outcomes in a Real-world Setting. Diabetes Care 2024; 47:216-224. [PMID: 37948469 DOI: 10.2337/dc23-1355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/22/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE Advanced hybrid closed-loop systems (AHCL) have been shown to improve glycemic control and patient-reported outcomes in type 1 diabetes. The aim was to analyze the outcomes of two commercially available AHCL in real life. RESEARCH DESIGN AND METHODS A prospective study was performed, including adolescents and adults with type 1 diabetes, AHCL naïve, from 14 centers, who initiated the use of MM780G with SmartGuard or Tandem t:slimX2 with Control-IQ. Baseline and 3-month evaluations were performed, assessing HbA1c, time in different glycemic ranges, and patient-reported outcomes. The primary outcome was the between-group time in range 70-180 mg/dL difference from beginning to end of follow-up. RESULTS One hundred fifty participants were included, with 75 initiating each system (age: 39.9 ± 11.4 years [16-72]; 64% female; diabetes duration: 21.6 ± 11.9 years). Time in range increased from 61.53 ± 14.01% to 76.17 ± 9.48% (P < 0.001), with no between-group differences (P = 0.591). HbA1c decreased by 0.56% (95% CI 0.44%, 0.68%) (6 mmol/mol, 95% CI 5, 7) (P < 0.001), from 7.43 ± 1.07% to 6.88 ± 0.60% (58 ± 12 to 52 ± 7 mmol/mol) in the MM780G group, and from 7.14 ± 0.70% to 6.56 ± 0.53% (55 ± 8 to 48 ± 6 mmol/mol) in the Control-IQ group (both P < 0.001 to baseline, P = 0.819 between groups). No superiority of one AHCL over the other regarding fear of hypoglycemia or quality of life was found. Improvement in diabetes-related distress was higher in Control-IQ users (P = 0.012). Sleep quality was improved (PSQI: from 6.94 ± 4.06 to 6.06 ± 4.05, P = 0.004), without differences between systems. Experience with AHCL, evaluated by the INSPIRE measures, exceeded the expectations. CONCLUSIONS The two AHCL provide significant improvement in glucose control and satisfaction, with no superiority of one AHCL over the other.
Collapse
Affiliation(s)
| | - Ana Chico
- Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Carmen Quirós
- Hospital Universitari Mutua de Terrassa, Barcelona, Spain
| |
Collapse
|
6
|
Seget S, Chobot A, Rusak E, Ochab A, Bielawska A, Polanska J, Jarosz-Chobot P. MiniMed 780GTM in children with type 1 diabetes under seven years of age: Prospective open-label, single-arm, double-center, follow-up study. Technol Health Care 2024; 32:1463-1472. [PMID: 37781828 DOI: 10.3233/thc-230490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
BACKGROUND Given the steadily rising incidence of type 1 diabetes (T1D), particularly among the youngest preschool children, coupled with well-documented challenges of achieving and maintaining optimal metabolic control in this age group, there is a growing need for advanced technological devices. OBJECTIVE To evaluate glycaemic control in children below the age of seven with type 1 diabetes (T1D) and assess the safety of the advanced hybrid closed loop (AHCL) system in comparison to the previous treatment method, a sensor-augmented pump with predictive low-glucose suspend (SAP-PLGS). METHOD Data from 10 children (aged 2.60-6.98 years) with T1D who transitioned to the AHCL system from SAP-PLGS were analysed. SAP-PLGS records from two weeks prior to the initiation of AHCL were compared with records from the initial four weeks post-switch (excluding the training period). These data were examined at two 2-week intervals and compared with records from two weeks post six-month usage of the AHCL. RESULTS A significant decrease in the average nighttime glucose concentration was observed compared to pre-AHCL values (p= 0.001, concordance W = 0.53). The Glucose Management Indicator (GMI) value significantly decreased from 6.88 ± 0.37% to 6.52 ± 0.32% (p= 0.018, rbc = 0.93) immediately following the device switch and stabilized at 6.50 ± 0.28% (p= 0.001, W = 0.53) and 6.55 ± 0.41% (p= 0.001, W = 0.53) at subsequent stages of the study. An improvement was also observed in mean glucose values for time spent < 54 mg/dl, while the proportion of time within this range was maintained, both during the day (p< 0.001, W = 0.58) and at night (p= 0.002, W = 0.83). CONCLUSION The AHCL MiniMed 780GTM system improved glycaemic control in the studied group of children under seven years of age with T1D compared to previous SAP-PLGS therapy. It proved to be safe for delivering insulin in this age group.
Collapse
Affiliation(s)
- Sebastian Seget
- Department of Children's Diabetology, Medical University of Silesia, Katowice, Poland
| | - Agata Chobot
- Department of Pediatrics, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Ewa Rusak
- Department of Children's Diabetology, Medical University of Silesia, Katowice, Poland
| | - Agnieszka Ochab
- Department of Pediatrics, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Anna Bielawska
- Department of Children's Diabetology, Medical University of Silesia, Katowice, Poland
| | - Joanna Polanska
- Department of Data Science and Engineering, Silesian University of Technology, Gliwice, Poland
| | | |
Collapse
|
7
|
ElSayed NA, Aleppo G, Bannuru RR, Bruemmer D, Collins BS, Ekhlaspour L, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Stanton RC, Gabbay RA. 14. Children and Adolescents: Standards of Care in Diabetes-2024. Diabetes Care 2024; 47:S258-S281. [PMID: 38078582 PMCID: PMC10725814 DOI: 10.2337/dc24-s014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
Collapse
|
8
|
Rossi A, Montefusco L, Reseghetti E, Pastore IF, Rossi G, Usuelli V, Loretelli C, Boci D, Ben Nasr M, D'Addio F, Bucciarelli L, Argenti S, Morpurgo P, Lunati ME, Fiorina P. Daytime hypoglycemic episodes during the use of an advanced hybrid closed loop system. Diabetes Res Clin Pract 2023; 206:111011. [PMID: 37956944 DOI: 10.1016/j.diabres.2023.111011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/30/2023] [Accepted: 11/10/2023] [Indexed: 11/19/2023]
Abstract
AIMS The use of advanced hybrid closed loop systems is spreading due to the beneficial effects on glycometabolic control obtained in patients with type 1 diabetes. However, hypoglycemic episodes can be sometimes a matter of concern. We aim to compare the hypoglycemic risk of an advanced hybrid closed loop system and a predictive low glucose suspend sensor augmented pump. METHODS In this retrospective three months observational study, we included 30 patients using Medtronic Minimed™ 780G advanced hybrid closed loop system and 30 patients using a Medtronic Minimed™ predictive low glucose suspend sensor augmented pump. RESULTS The advanced hybrid closed loop system reduced the time spent above 180 mg/dL threshold and increased the time in range as compared to the predictive low glucose suspend. No severe hypoglycemia occurred in both groups and no differences were observed in the percentage of time spent below 70 mg/dl and 54 mg/dl glucose threshold. Nevertheless, more hypoglycemic episodes were recorded during daytime, but not in nighttime, with the use of the advanced hybrid closed loop system. CONCLUSIONS Our results confirmed the general improvement of glycemic outcomes obtained with the advanced hybrid closed loop system; however more hypoglycemic episodes during daytime were evident.
Collapse
Affiliation(s)
- Antonio Rossi
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Laura Montefusco
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Elia Reseghetti
- Dept. Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | | | - Giada Rossi
- Dept. Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Vera Usuelli
- Dept. Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Cristian Loretelli
- Dept. Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy; International Center for T1D - Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Milan, Italy
| | - Denisa Boci
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Moufida Ben Nasr
- Dept. Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy; International Center for T1D - Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Milan, Italy
| | - Francesca D'Addio
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy; Dept. Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy; International Center for T1D - Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Milan, Italy
| | | | - Sabrina Argenti
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Paola Morpurgo
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | | | - Paolo Fiorina
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy; Dept. Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy; International Center for T1D - Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, Milan, Italy; Nephrology Division, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.
| |
Collapse
|
9
|
Piccini B, Felicioni M, Pessina B, Bertini M, Casalini E, Ceccotti C, Farina S, Ferrari M, Lenzi L, Monzali F, Toni S. Glycemic Control, Basal/Bolus Distribution, BMI and Meal Management in Children and Adolescents with Type 1 Diabetes and Advanced Hybrid Closed Loop. Nutrients 2023; 15:4875. [PMID: 38068733 PMCID: PMC10707798 DOI: 10.3390/nu15234875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/14/2023] [Accepted: 11/17/2023] [Indexed: 12/18/2023] Open
Abstract
Evidence about the impact of advanced hybrid closed loop (AHCL) on body mass index (BMI) and eating habits in children with type 1 diabetes (T1D) is lacking. This real-world study aimed at evaluating glycemic control, BMI, meals and basal/bolus distribution in young subjects with T1D treated by AHCL. Glycemic metrics, HbA1c, basal/bolus distribution, meals/day, BMI, total daily dose (TDD), and carbohydrates/kg (CHO/kg) have been evaluated in 83 subjects, aged 13 ± 4.5 years, in manual mode, 3 and 6 months after auto-mode. Time in range (TIR) increased after 3 months, exceeding the target of 70% and was maintained at 6 months. While coefficient of variation (CV) did not change, the glucose management indicator (GMI) decreased in auto-mode (6.7 ± 0.3 vs. 7.1 ± 0.5%; p < 0.001), as well as HbA1c. Basal proportion decreased in favor of boluses (38.3 ± 7.3 vs. 43.6 ± 10.9%; p < 0.001). Meals increased at 3 and 6 months (4.4 ± 1.2 vs. 5.0 ± 1.5, p 0.002 and 5.1 ± 1.7, p < 0.001), as well as TDD/kg, without changes in BMI and CHO consumed. No differences in meal composition have arisen from food diaries. In conclusion, AHCL ensured the achievement and maintenance of target TIR in young T1D subjects. The number of meals, TDD, and insulin bolus proportion increased over time, but BMI remained stable.
Collapse
Affiliation(s)
- Barbara Piccini
- Endocrinology and Diabetology Unit, Meyer University Children’s Hospital IRCCS, 50139 Florence, Italy; (S.F.); (M.F.); (L.L.); (S.T.)
| | - Matteo Felicioni
- Department of Pediatrics, University of Perugia, 06156 Perugia, Italy;
| | - Benedetta Pessina
- Department of Pediatrics, Meyer University Children’s Hospital IRCCS, University of Florence, 50139 Florence, Italy;
| | - Mattia Bertini
- Department of Pediatrics, Santa Maria Alle Scotte University Hospital, University of Siena, 53100 Siena, Italy; (M.B.); (C.C.)
| | - Emilio Casalini
- Department of Pediatrics, Istituto Giannina Gaslini, University of Genova, 16147 Genova, Italy;
| | - Chiara Ceccotti
- Department of Pediatrics, Santa Maria Alle Scotte University Hospital, University of Siena, 53100 Siena, Italy; (M.B.); (C.C.)
| | - Silvia Farina
- Endocrinology and Diabetology Unit, Meyer University Children’s Hospital IRCCS, 50139 Florence, Italy; (S.F.); (M.F.); (L.L.); (S.T.)
| | - Marta Ferrari
- Endocrinology and Diabetology Unit, Meyer University Children’s Hospital IRCCS, 50139 Florence, Italy; (S.F.); (M.F.); (L.L.); (S.T.)
| | - Lorenzo Lenzi
- Endocrinology and Diabetology Unit, Meyer University Children’s Hospital IRCCS, 50139 Florence, Italy; (S.F.); (M.F.); (L.L.); (S.T.)
| | - Francesca Monzali
- Dietology Unit, Meyer University Children’s Hospital IRCCS, 50139 Florence, Italy;
| | - Sonia Toni
- Endocrinology and Diabetology Unit, Meyer University Children’s Hospital IRCCS, 50139 Florence, Italy; (S.F.); (M.F.); (L.L.); (S.T.)
| |
Collapse
|
10
|
Prahalad P, Hardison H, Odugbesan O, Lyons S, Alwazeer M, Neyman A, Miyazaki B, Cossen K, Hsieh S, Eng D, Roberts A, Clements MA, Ebekozien O. Benchmarking Diabetes Technology Use Among 21 U.S. Pediatric Diabetes Centers. Clin Diabetes 2023; 42:27-33. [PMID: 38230344 PMCID: PMC10788667 DOI: 10.2337/cd23-0052] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
The American Diabetes Association's Standards of Care in Diabetes recommends the use of diabetes technology such as continuous glucose monitoring systems and insulin pumps for people living with type 1 diabetes. Unfortunately, there are multiple barriers to uptake of these devices, including local diabetes center practices. This study aimed to examine overall change and center-to-center variation in uptake of diabetes technology across 21 pediatric centers in the T1D Exchange Quality Improvement Collaborative. It found an overall increase in diabetes technology use for most centers from 2021 to 2022 with significant variation.
Collapse
Affiliation(s)
- Priya Prahalad
- Stanford Children’s Health, Lucile Packard Children’s Hospital, Stanford, CA
| | | | | | - Sarah Lyons
- Baylor College of Medicine/Texas Children’s Hospital, Houston, TX
| | | | - Anna Neyman
- UH Rainbow Babies & Children’s Hospital, Cleveland, OH
| | | | | | - Susan Hsieh
- Cook Children’s, Endocrinology, Fort Worth, TX
| | - Donna Eng
- Pediatric Endocrinology, Spectrum Health, Helen DeVos Children’s Hospital, Grand Rapids, MI
| | | | | | - Osagie Ebekozien
- T1D Exchange, Boston, MA
- University of Mississippi School of Population Health, Jackson, MS
| | | |
Collapse
|
11
|
Elhenawy YI, Shaarawy MA, Selim EM. Safety and efficacy of the structured onboarding steps and initiation protocol for MiniMed™ 780G system among an Egyptian cohort of young people living with type 1 diabetes. J Pediatr Endocrinol Metab 2023; 36:941-948. [PMID: 37658752 DOI: 10.1515/jpem-2023-0250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/11/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVES The aim of the current study was to evaluate the safety and efficacy of initiation protocol for MiniMed ™ 780G system among an Egyptian cohort of young people living with type 1 diabetes (T1D). METHODS A prospective single-arm study including 72 participants with T1D. Five days of structured education and training were provided to all users and continuous glucose monitoring (CGM) was initiated on the first day of the training. Users initiated the pump initially in manual mode, with suspend before low feature, for 3 days before shifting to Auto Mode. RESULTS The mean HbA1c decreased from 8.72 ± 2.01 % to 6.7 ± 0.4 % (p<0.01). Time in range (70-180 mg/dL) substantially improved from 55.24 % ± 10.35 to 81.7 % ± 5.12 % after spending 84 days in auto mode (p<0.001) with 2.03 % of the time spent below 70 mg/dL. Regarding AHCL compatibility, users spent at least 90 % of time in auto mode. CONCLUSIONS Young people with T1D successfully initiated the AHCL system, using a tailored structured on-boarding protocol. Structured stepwise initiation protocol and onboarding steps are important prerequisite for participants' adherence and engagement with the system. Patient education together with optimized pump settings are important predictors of glycemic outcomes.
Collapse
Affiliation(s)
- Yasmine I Elhenawy
- Pediatric and Adolescent Diabetes Unit (PADU), Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Esraa M Selim
- Diabetes Educator and Certified Pump Educator, Cairo, Egypt
| |
Collapse
|
12
|
Elbarbary NS, Ismail EAR. MiniMed 780G™ advanced hybrid closed-loop system performance in Egyptian patients with type 1 diabetes across different age groups: evidence from real-world users. Diabetol Metab Syndr 2023; 15:205. [PMID: 37845757 PMCID: PMC10580510 DOI: 10.1186/s13098-023-01184-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/08/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Advanced hybrid closed loop (AHCL) system provides both automated basal rate and correction boluses to keep glycemic values in a target range. OBJECTIVES To evaluate the real-world performance of the MiniMed™ 780G system among different age groups of Egyptian patients with type 1diabetes. METHODS One-hundred seven AHCL system users aged from 3 to 71 years were enrolled. Data uploaded by patients were aggregated and analyzed. The mean glucose management indicator (GMI), percentage of time spent within glycemic ranges (TIR), time below range (TBR) and time above range (TAR) were determined. RESULTS Six months after initiating Auto Mode, patients spent a mean of 85.31 ± 22.04% of the time in Auto Mode (SmartGuard) and achieved a mean GMI of 6.95 ± 0.58% compared with 7.9 ± 2.1% before AHCL initiation (p < 0.001). TIR 70-180 mg/dL was increased post-AHCL initiation from 63.48 ± 10.14% to 81.54 ± 8.43% (p < 0.001) while TAR 180-250 mg/dL, TAR > 250 mg/dL, TBR < 70 mg/dL and TBR < 54 mg/dL were significantly decreased (p < 0.001). After initiating AHCL, TIR was greater in children and adults compared with adolescents (82.29 ± 7.22% and 83.86 ± 9.24% versus 78.4 ± 7.34%, respectively; p < 0.05). The total daily dose of insulin was increased in all age groups primarily due to increased system-initiated insulin delivery including auto correction boluses and basal insulin. CONCLUSIONS MiniMed™ 780G system users across different age groups achieved international consensus-recommended glycemic control with no serious adverse effects even in challenging age group as children and adolescents.
Collapse
Affiliation(s)
- Nancy Samir Elbarbary
- Department of Pediatrics, Faculty of medicine, Ain shams University, 25 Ahmed Fuad St. Saint Fatima, Cairo, 11361, Egypt.
| | | |
Collapse
|
13
|
Genève P, Adam T, Delawoevre A, Jellimann S, Legagneur C, DiPatrizio M, Renard E. High incidence of skin reactions secondary to the use of adhesives in glucose sensors or insulin pumps for the treatment of children with type 1 diabetes. Diabetes Res Clin Pract 2023; 204:110922. [PMID: 37769906 DOI: 10.1016/j.diabres.2023.110922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/11/2023] [Accepted: 09/23/2023] [Indexed: 10/02/2023]
Abstract
AIMS To evaluate the incidence of the skin reactions secondary to continuous subcutaneous insulin infusion (CSII) or continuous glucose monitoring (CGM), sensors and the characteristics of affected children with type 1 diabetes. METHODS An observational, retrospective, single-centre study included 198 children with type 1 diabetes, (46% girls, mean age 11.75 years). A standardised questionnaire was completed with the patient during current care to evaluate the skin reactions (mean and percentage), the type of reaction, their impact and the treatment) and the characteristics of affected children with univariate and multivariate analysis. RESULTS Sixty-seven children (33.8%) reported active skin reactions: 45 children with CSII (30.4%) and 46 with CGM (23.5%). Children with skin reactions were younger (mean age 10.6 yo versus 12.34 yo, p < 0.05), with a younger age at the diagnosis of diabetes (5.59 yo versus 7.08 yo, p < 0.05). Atopy was more frequent in the group with skin reactions (76.1% versus 54.1% p < 0.05). On multivariate analysis, only the personal history of atopy was associated with skin reactions: OR 2.56 [1.16-5.97] (p < 0.05). CONCLUSION This study confirms the high incidence of skin reactions to adhesive devices used in the treatment of type 1 diabetes in children.
Collapse
Affiliation(s)
- P Genève
- Pediatric Endocrinology and Diabetology Unit, Children's Hospital, University Hospital of Nancy, France
| | - T Adam
- Department of Allergology, Children's Hospital, University Hospital of Nancy, France
| | - A Delawoevre
- Pediatric Endocrinology and Diabetology Unit, Children's Hospital, University Hospital of Nancy, France
| | - S Jellimann
- Pediatric Endocrinology and Diabetology Unit, Children's Hospital, University Hospital of Nancy, France
| | - C Legagneur
- Pediatric Endocrinology and Diabetology Unit, Children's Hospital, University Hospital of Nancy, France
| | - M DiPatrizio
- Pediatric Endocrinology and Diabetology Unit, Children's Hospital, University Hospital of Nancy, France
| | - E Renard
- Pediatric Endocrinology and Diabetology Unit, Children's Hospital, University Hospital of Nancy, France; INSERM UMR_S 1256, Nutrition, Genetics, and Environmental Risk Exposure (NGERE), Faculty of Medicine of Nancy, University of Lorraine, Nancy, France.
| |
Collapse
|
14
|
Eviz E, Yesiltepe Mutlu G, Karakus KE, Can E, Gokce T, Muradoglu S, Hatun S. The Advanced Hybrid Closed Loop Improves Glycemia Risk Index, Continuous Glucose Monitoring Index, and Time in Range in Children with Type 1 Diabetes: Real-World Data from a Single Center Study. Diabetes Technol Ther 2023; 25:689-696. [PMID: 37449922 DOI: 10.1089/dia.2023.0112] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Introduction: The Glycemia Risk Index (GRI) and Continuous Glucose Monitoring Index (COGI) are newly defined composite metric parameters derived from continuous glucose monitoring (CGM) data. GRI is divided into five separate risk zones (from lowest to highest: A-E). In this study, the effect of the advanced hybrid closed loop (AHCL) system on GRI and COGI in children with type 1 diabetes was evaluated. Materials and Methods: Forty-five children who had started using the AHCL and whose baseline and sixth-month CGM data were available were analyzed in terms of achievement of CGM consensus goals and changes in GRI scores and zones. The paired t-test was used for the analyses. Results: The mean age and duration of diabetes of the participants were 10.95 ± 3.41 and 3.85 ± 2.67 years, respectively. The mean GRI score significantly decreased from 35.66 ± 17.46 at baseline to 22.83 ± 9.08 at 6 months (P < 0.001). Although the proportion of those in the A zone was 20% at baseline, it increased to 42% at 6 months. AHCL also improved COGI from 72.59 ± 12.44 to 82.90 ± 7.72 (P < 0.001). Time in range (TIR) increased significantly from 70.54% to 80.51% (P < 0.001) at 6 months. Conclusion: AHCL provides not only an improvement in TIR but also a significant improvement in both GRI and COGI at 6 months. The incorporation of GRI and COGI alongside TIR may enhance the assessment of the glycemic profile by providing a more comprehensive and in-depth analysis.
Collapse
Affiliation(s)
- Elif Eviz
- Division of Pediatric Endocrinology and Diabetes, Koc University School of Medicine, Istanbul, Turkey
- Division of Pediatric Endocrinology and Diabetes, Koc University Hospital, Istanbul, Turkey
| | - Gul Yesiltepe Mutlu
- Division of Pediatric Endocrinology and Diabetes, Koc University School of Medicine, Istanbul, Turkey
- Division of Pediatric Endocrinology and Diabetes, Koc University Hospital, Istanbul, Turkey
| | - Kagan Ege Karakus
- Division of Pediatric Endocrinology and Diabetes, Koc University School of Medicine, Istanbul, Turkey
| | - Ecem Can
- Division of Pediatric Endocrinology and Diabetes, Koc University Hospital, Istanbul, Turkey
| | - Tugba Gokce
- Division of Pediatric Endocrinology and Diabetes, Koc University Hospital, Istanbul, Turkey
| | - Serra Muradoglu
- Division of Pediatric Endocrinology and Diabetes, Koc University Hospital, Istanbul, Turkey
| | - Sukru Hatun
- Division of Pediatric Endocrinology and Diabetes, Koc University School of Medicine, Istanbul, Turkey
- Division of Pediatric Endocrinology and Diabetes, Koc University Hospital, Istanbul, Turkey
| |
Collapse
|
15
|
Papa G, Cannarella R, Condorelli RA, Finocchiaro C, Calogero AE, La Vignera S. Glycometabolic outcomes in adult type 1 diabetic patients switching to closed-loop systems. Diabetes Res Clin Pract 2023; 204:110907. [PMID: 37708979 DOI: 10.1016/j.diabres.2023.110907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/03/2023] [Accepted: 09/11/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE This study aimed to evaluate glycometabolic outcomes in AID technology-naïve T1D patients after switching to Hybrid Closed Loop (HCL) and Advanced Hybrid Closed Loop (AHCL) systems. RESEARCH DESIGN AND METHODS This was a 12-month, prospective, observational, two-center study on 54 type 1 diabetes (T1D) patients aged 19-65 years managed with multiple daily injections (MDI) or Continuous Subcutaneous Insulin Infusion (CSII) in open-loop to evaluate the superiority in terms of effectiveness and safety of Automated Insulin Delivery (AID) systems. RESULTS HbA1c levels significantly improved at the end of the study. Time spent with glucose levels in target range (TIR70-180 mg/dL, 3.9-10 mmol/L) increased from 50.5 ± 15.6% at baseline to 73.6 ± 8.0% at 12 months (p < 0.001); time spent above range (TAR180-250 mg/dL, 10-13.9 mmol/L and TAR≥250 mg/dL, 13.9 mmol/L) decreased from 30.6 ± 9.0% and 14.2 ± 10.2 at baseline to 19.3 ± 5.3% and 4.8 ± 3.3% at 12 months (p < 0.001 for both), respectively; time spent below range (TBR54-69 mg/dL, 3-3.8 mmol/L and TBR<54 mg/dL, 3.0 mmol/L) decreased from 3.5 ± 2.6% and 1.2 ± 1.4% at baseline to 1.9 ± 1.5% and 0.4 ± 0.7% at the end of the study (p < 0.001 for both); coefficient of variation (CV) decreased from 35.9 ± 7.8% at baseline to 33.0 ± 5.3% (p < 0.05). Satisfaction with the new technology was scored as high. CONCLUSION AID-naïve T1D patients switching to HCL/AHCL systems have significantly and safely improved their glycometabolic outcomes with their high satisfaction with the new type of treatment.
Collapse
Affiliation(s)
- Giuseppe Papa
- Unit of Metabolic and Endocrine Disease, "Centro Catanese di Medicina e Chirurgia" Clinic, Catania, Italy
| | - Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy; Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Rosita A Condorelli
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Concetta Finocchiaro
- Unit of Metabolic and Endocrine Disease, "Centro Catanese di Medicina e Chirurgia" Clinic, Catania, Italy
| | - Aldo E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
| | - Sandro La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| |
Collapse
|
16
|
Navas Moreno V, Sebastian-Valles F, Sampedro-Nuñez M, Lahera Vargas M, Marazuela M, Arranz Martin JA. Patient satisfaction in three advanced hybrid closed-loop systems at 6 months of treatment in adults with type 1 diabetes mellitus: a follow-up study. ENDOCRINOL DIAB NUTR 2023; 70:548-555. [PMID: 37858412 DOI: 10.1016/j.endien.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/21/2023] [Accepted: 06/28/2023] [Indexed: 10/21/2023]
Abstract
INTRODUCTION Advanced hybrid closed-loop (AHCL) systems have demonstrated improved glycemic control in individuals with Type 1 Diabetes Mellitus. The aim of this study is to compare patient satisfaction among three available AHCL systems (Medtronic Minimed780 G, Roche Diabeloop DBLG1, and Tandem t:slim X2 Control IQ) after six months of treatment and to determine if it is related to glycemic control. METHODS The data of 75 individuals were analyzed, including 15 using the DBLG1 system, 9 using Control IQ, and 51 using MM780 G. Patient satisfaction was assessed using the Diabetes Treatment Satisfaction Questionnaire for Diabetes Mellitus (DTSQc), a validated instrument. RESULTS All systems demonstrated treatment satisfaction. The DBLG-1 system scored 14 (-15-21) points, while Control IQ scored 21 (9-24) and M780 G scored 19 (11-24) (p = 0.004). The multivariate analysis revealed that the DBLG-1 system is associated with a lower DTSQc score (OR 0.19, p = 0.019) independent of glycemic control, sex, age, duration of diabetes, duration as an insulin pump user, and daily insulin dose. CONCLUSION AHCL systems are satisfactory treatments for users, with potential variations observed between each system regardless of the achieved glycemic control.
Collapse
Affiliation(s)
- Victor Navas Moreno
- Servicio de Endocrinología y Nutrición, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Fernando Sebastian-Valles
- Servicio de Endocrinología y Nutrición, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, Madrid, Spain.
| | - Miguel Sampedro-Nuñez
- Servicio de Endocrinología y Nutrición, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Marcos Lahera Vargas
- Servicio de Endocrinología y Nutrición, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Monica Marazuela
- Servicio de Endocrinología y Nutrición, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - José Alfonso Arranz Martin
- Servicio de Endocrinología y Nutrición, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| |
Collapse
|
17
|
Rachmiel M, Lebenthal Y, Mazor-Aronovitch K, Brener A, Levek N, Jacobi-Polishook T, Ben Ari T, Abiri S, Landau Z, Pinhas-Hamiel O. MiniMed 780G Advanced Hybrid Closed-Loop System Outcomes According to Pubertal Status: Awesome Study Group Real-Life Experience. Diabetes Technol Ther 2023; 25:643-651. [PMID: 37219952 DOI: 10.1089/dia.2023.0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Background and Aims: Achieving good glycemic control is a major challenge for adolescents with type 1 diabetes (TID). The introduction of the MiniMed 780G system, an advanced hybrid closed-loop (AHCL) that enables an automatic correction of insulin, gave hope for improved glycemic outcomes in adolescents. We assessed specific characteristics associated with glycemic measures in youth with T1D switching to Minimed 780G. Methods: This retrospective observational real-life multicenter study from the AWeSoMe Group assessed continuous glucose monitoring (CGM) metrics of 22 patients (59% females, median age 13.9 interquartile range [IQR 11,18] years), from a high socioeconomic background. CGM metrics were recorded for 2-week periods before AHCL, after 1, 3, 6 months, and at the end of follow-up (median 10.9 [IQR 5.4, 17.4] months). Delta-variables (Δ) were calculated as the difference between the end of follow-up and baseline. Results: Time in range (TIR)70-180mg/dL increased from 65% [52, 72] to 75% [63, 80], P = 0.008, from baseline to end of follow-up. Time above range>180mg/dL decreased from 28% [20, 46] to 22% [14, 35], P = 0.047. Advanced pubertal stage was correlated with less improvement in ΔTAR>180mg/dL, r = 0.47, P = 0.05, and less CGM usage r = -0.57, P = 0.05. A longer disease duration was associated with less improvement in ΔTAR180-250mg/dL, r = 0.48, P = 0.05. Lower pump site change frequency was associated with higher glucose management indicator, r = 0.5, P = 0.03, and lower TIR70-180mg/dL r = -0.52, P = 0.08. Conclusion: The use of AHCL enabled improvements in TIR70-180mg/dL in youth with T1D. More advanced pubertal stages, longer disease duration, and less compliance were associated with less improvement, stressing the need for continuous support, and re-education in this age group.
Collapse
Affiliation(s)
- Marianna Rachmiel
- Pediatric Endocrinology Unit, Shamir (Assaf Harofeh) Medical Center, Beer Yaakov, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Lebenthal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Kineret Mazor-Aronovitch
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- National Juvenile Diabetes Center, Maccabi Health Care Services, Ra'anana, Israel
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Avivit Brener
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Noah Levek
- National Juvenile Diabetes Center, Maccabi Health Care Services, Ra'anana, Israel
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Talia Jacobi-Polishook
- Pediatric Endocrinology Unit, Shamir (Assaf Harofeh) Medical Center, Beer Yaakov, Israel
| | - Tal Ben Ari
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Endocrine and Diabetes Unit, E. Wolfson Medical Center, Holon, Israel
| | - Shirli Abiri
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Endocrine and Diabetes Unit, E. Wolfson Medical Center, Holon, Israel
| | - Zohar Landau
- National Juvenile Diabetes Center, Maccabi Health Care Services, Ra'anana, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Orit Pinhas-Hamiel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- National Juvenile Diabetes Center, Maccabi Health Care Services, Ra'anana, Israel
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat-Gan, Israel
| |
Collapse
|
18
|
Shalit R, Minsky N, Laron-Hirsh M, Cohen O, Kurtz N, Roy A, Grosman B, Benedetti A, Tirosh A. Unannounced Meal Challenges Using an Advanced Hybrid Closed-Loop System. Diabetes Technol Ther 2023; 25:579-588. [PMID: 37335759 DOI: 10.1089/dia.2023.0139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Background: The advanced hybrid closed-loop (AHCL) algorithm combines automated basal rates and corrections yet requires meal announcement for optimal outcomes. We aimed to compare the performance of the MiniMed™ 780G AHCL algorithm with and without meal announcement. Methods: In a single-arm study involving 14 adults with type 1 diabetes, we evaluated the safety and efficacy of AHCL when meals were not announced. Participants stayed at a supervised environment for 5 days, during which the outcomes of not announcing meals (≤80 g of carbohydrate) were assessed. Next, participants entered a 90-day at-home "unannounced" phase, during which all meals (≤80 g of carbohydrate) were unannounced, followed by a 90-day at-home phase in which all meals were announced. Results: Time in range (TIR 70-180 mg/dL) was lower in the unannounced versus announced periods (67.5% ± 12.5% vs. 77.7% ± 9.5%; P < 0.01, respectively), with more time spent in hyperglycemia range 180-250 mg/dL (22.7% ± 7.7% vs. 15.7% ± 7.2%) and >250 mg/dL (7.9% ± 6.4% vs. 3.6% ± 2.7%), but less time in hypoglycemia range 54-70 mg/dL (1.6% ± 1% vs. 2.8% ± 1.8%) and <54 mg/dL (0.3% ± 0.4% vs. 0.7% ± 0.9%). Not announcing meals containing up to 60 g of carbohydrate did not lead to increase in postprandial extreme dysglycemia >250 mg/dL, and up to 20 g of unannounced carbohydrates did not significantly change the TIR 70-180 mg/dL compared with full announcement. Conclusion: The AHCL system is optimized for use with meal announcement. While not announcing meals of ≤80 g carbohydrates appears to be safe, it results in suboptimal postprandial glycemic control, especially with high-carbohydrate meals. Not announcing small meals (≤20 g carbohydrate) does not deteriorate glycemic control. Clinical Trial Registration number: NCT04479826.
Collapse
Affiliation(s)
- Roy Shalit
- Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel-Hashomer, Israel
| | - Noga Minsky
- Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel-Hashomer, Israel
| | - Maya Laron-Hirsh
- Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel-Hashomer, Israel
| | - Ohad Cohen
- Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel-Hashomer, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Medtronic, Northridge, California, USA
| | | | | | | | | | - Amir Tirosh
- Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel-Hashomer, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
19
|
Wannes S, Gamal GM, Fredj MB, Al Qusayer D, El Abed S, Sedky Y, Khalil M. Glucose control during Ramadan in a pediatric cohort with type 1 diabetes on MiniMed standard and advanced hybrid closed‑loop systems: A pilot study. Diabetes Res Clin Pract 2023; 203:110867. [PMID: 37544364 DOI: 10.1016/j.diabres.2023.110867] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/31/2023] [Accepted: 08/03/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Hybrid closed-loop (HCL) systems have revolutionized the treatment of diabetes, enabling doctors to cope with challenging conditions that were previously almost impossible to manage or were very risky and difficult. AIMS To assess the efficacy and safety of a hybrid closed-loop (HCL) system during Ramadan fasting in a pediatric cohort with type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS Glucose control outcomes in older children and adolescents aged 8-16 years with automated insulin delivery for T1D were analyzed during Ramadan and 1 month before Ramadan. Participants on MiniMed standard HCL (670G) or advanced HCL (780G) systems of Medtronic were categorized as fasting or nonfasting. RESULTS The average age of the 19 participants (8 and 11 were on standard and advanced HCL systems, respectively) was 11.35 ± 2 years. Eleven patients fasted during Ramadan. Pump setup and sensor statistics were the same during Ramadan and the month before; no significant difference was found between the two groups in terms of insulin and glucose control metrics, with practically the same coefficient of variation, time in range (TIR) and time spent in hypoglycemia, maintained within the international recommended targets. Total daily doses were paradoxically higher in patients who fasted during Ramadan (p = 0.01), without repercussions on glucose control metrics. CONCLUSIONS Standard and advanced HCL use during Ramadan were safe and were associated with a maintained optimum TIR (>70 %) and no significant hypoglycemia in adolescents and older children with T1D.
Collapse
Affiliation(s)
- Selmen Wannes
- Department of Pediatrics, Mouwasat Hospital, Imam Al Termithy Street, Uhud, 32263 Dammam, Saudi Arabia; Faculty of Medicine of Monastir, University of Monastir, 5019 Monastir, Tunisia; Department of Pediatrics, University Hospital Thar Sfar de Mahdia, 5100 Mahdia, Tunisia.
| | - Gehad Mohamed Gamal
- Department of Pediatrics, Mouwasat Hospital, Imam Al Termithy Street, Uhud, 32263 Dammam, Saudi Arabia; Beni-Suef University, Beni-Suef, Egypt
| | - Manel Ben Fredj
- Faculty of Medicine of Monastir, University of Monastir, 5019 Monastir, Tunisia; Department of Epidemiology, University Hospital Fattouma Bourguiba, 5019 Monastir, Tunisia
| | - Dhai Al Qusayer
- Department of Pediatrics, Mouwasat Hospital, Imam Al Termithy Street, Uhud, 32263 Dammam, Saudi Arabia
| | - Sameh El Abed
- Diabetic Center, Mouwasat Hospital, Imam Al Termithy Street, Uhud, 32263 Dammam, Saudi Arabia
| | - Yasser Sedky
- Department of Pediatrics, Mouwasat Hospital, Imam Al Termithy Street, Uhud, 32263 Dammam, Saudi Arabia; Department of Pediatrics, Cairo University, Egypt
| | - Munther Khalil
- Department of Pediatrics, Mouwasat Hospital, Imam Al Termithy Street, Uhud, 32263 Dammam, Saudi Arabia
| |
Collapse
|
20
|
Cambuli VM, Baroni MG. Intelligent Insulin vs. Artificial Intelligence for Type 1 Diabetes: Will the Real Winner Please Stand Up? Int J Mol Sci 2023; 24:13139. [PMID: 37685946 PMCID: PMC10488097 DOI: 10.3390/ijms241713139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
Research in the treatment of type 1 diabetes has been addressed into two main areas: the development of "intelligent insulins" capable of auto-regulating their own levels according to glucose concentrations, or the exploitation of artificial intelligence (AI) and its learning capacity, to provide decision support systems to improve automated insulin therapy. This review aims to provide a synthetic overview of the current state of these two research areas, providing an outline of the latest development in the search for "intelligent insulins," and the results of new and promising advances in the use of artificial intelligence to regulate automated insulin infusion and glucose control. The future of insulin treatment in type 1 diabetes appears promising with AI, with research nearly reaching the possibility of finally having a "closed-loop" artificial pancreas.
Collapse
Affiliation(s)
- Valentina Maria Cambuli
- Diabetology and Metabolic Diseaseas, San Michele Hospital, ARNAS Giuseppe Brotzu, 09121 Cagliari, Italy;
| | - Marco Giorgio Baroni
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
- Neuroendocrinology and Metabolic Diseases, IRCCS Neuromed, 86077 Pozzilli, Italy
| |
Collapse
|
21
|
Lendínez‐Jurado A, Gómez‐Perea A, Ariza‐Jiménez AB, Tapia‐Ceballos L, Becerra‐Paz I, Martos‐Lirio MF, Moreno‐Jabato F, Leiva‐Gea I. Impact on glucometric variables and quality of life of the advanced hybrid closed-loop system in pediatric and adolescent type 1 diabetes. J Diabetes 2023; 15:699-708. [PMID: 37337407 PMCID: PMC10415871 DOI: 10.1111/1753-0407.13426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/17/2023] [Accepted: 05/16/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND In recent years, technological advances in the field of diabetes have revolutionized the management, prognosis, and quality of life of diabetes patients and their environment. The aim of our study was to evaluate the impact of implementing the MiniMed 780G closed-loop system in a pediatric and adolescent population previously treated with a continuous subcutaneous insulin infusion pump and intermittent glucose monitoring. METHODS Data were collected from 28 patients with type 1 diabetes aged 6 to 17 years, with a follow-up of 6 months. We included both glucometric and quality of life variables, as well as quality of life in primary caregivers. Metabolic control variables were assessed at baseline (before system change) and at different cutoff points after initiation of the closed-loop system (48 hours, 7 days, 14 days, 21 days, 1 month, 3 months, 6 months). RESULTS Time in range 70-180 mg/dL increased from 59.44% at baseline to 74.29% in the first 48 hours after automation of the new system, and this improvement was maintained at the other cutoff points, as was time in hyperglycemia 180-250 mg/dL (24.44% at baseline to 18.96% at 48 hours) and >250 mg/dL (11.71% at baseline to 3.82% at 48 hours). CONCLUSIONS Our study showed an improvement in time in range and in all time spent in hyperglycemia from the first 48 hours after the automation of the system, which was maintained at 6 months.
Collapse
Affiliation(s)
- Alfonso Lendínez‐Jurado
- Department of Pediatric EndocrinologyRegional University Hospital of MalagaMálagaSpain
- Universidad de Málaga, Andalucía TechMálagaSpain
| | - Ana Gómez‐Perea
- Department of Pediatric EndocrinologyRegional University Hospital of MalagaMálagaSpain
- Instituto de Investigación Biomédica de Málaga (IBIMA)MálagaSpain
| | - Ana B. Ariza‐Jiménez
- Department of Pediatric EndocrinologyReina Sofia University HospitalCórdobaSpain
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de CórdobaCórdobaSpain
| | - Leopoldo Tapia‐Ceballos
- Department of Pediatric EndocrinologyRegional University Hospital of MalagaMálagaSpain
- Instituto de Investigación Biomédica de Málaga (IBIMA)MálagaSpain
| | - Icía Becerra‐Paz
- Department of Pediatric EndocrinologyRegional University Hospital of MalagaMálagaSpain
| | - María F. Martos‐Lirio
- Department of Pediatric EndocrinologyRegional University Hospital of MalagaMálagaSpain
- Universidad de Málaga, Andalucía TechMálagaSpain
| | - Fernando Moreno‐Jabato
- Instituto de Investigación Biomédica de Málaga (IBIMA)MálagaSpain
- Servicio de Supercomputación y Departamento de Arquitectura de ComputadoresUniversidad de MálagaMálagaSpain
| | - Isabel Leiva‐Gea
- Department of Pediatric EndocrinologyRegional University Hospital of MalagaMálagaSpain
- Universidad de Málaga, Andalucía TechMálagaSpain
- Instituto de Investigación Biomédica de Málaga (IBIMA)MálagaSpain
| |
Collapse
|
22
|
Kesavadev J, Basanth A, Krishnan G, Shankar A, Sanal G, Jothydev S. Real-World User and Clinician Perspective and Experience with MiniMed™ 780G Advanced Hybrid Closed Loop System. Diabetes Ther 2023:10.1007/s13300-023-01427-z. [PMID: 37278948 PMCID: PMC10299959 DOI: 10.1007/s13300-023-01427-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 05/18/2023] [Indexed: 06/07/2023] Open
Abstract
INTRODUCTION The advanced hybrid closed loop (AHCL) MiniMed™ 780G system changes basal insulin delivery every 5 min and auto bolus in response to sensor glucose values. We assessed the performance of the AHCL system in real-world settings for individuals with type 1 diabetes (T1DM) as well as user and clinician perspectives and satisfaction. METHODS We held two peer group discussions: one having adults with T1DM/parents of children and adolescents with T1DM to understand their experiences with the AHCL system and another with healthcare providers (HCPs). Responses from the discussions were analyzed and categorized into themes by two independent researchers, with any inconsistencies resolved by consensus. We also analyzed data from the system uploaded to CareLink personal software. Glycemic outcomes, including time in range (TIR), time below range (TBR), time above range (TAR), mean sensor glucose (SG) levels, glucose management indicator (GMI), sensor use, and percentage of time spent in AHCL, were determined. RESULTS The peer group discussions revealed numerous key themes and issues for each group, such as the significance of setting reasonable expectations, carbohydrate counting and bolus dosing, technical difficulties, and overall user experience. The users (n = 25; T1DM; 17 female; age 13.8 ± 7.49 years; A1C 6.54 ± 0.45%; duration of diabetes 6 ± 6.78 years) were very satisfied with the system. Most users experienced consistent blood glucose values with very few hypoglycemic episodes. However, there were a few limitations reported, such as hyperglycemic episodes caused by inaccuracies in carb counting, issues with sensor connectivity, and cannula blockages or kinking for those using insulin Fiasp. Users achieved a mean GMI of 6.4 ± 0.26%, TIR of 83.0 ± 8.12%, TBR (54-70 mg/dL) of 2.0 ± 0.81%, TBR* (< 54 mg/dL) of 0%. All of the users achieved a TIR of > 70%. CONCLUSION The use of the AHCL system in T1DM resulted in robust glycemic control, minimizing hypoglycemia. Providing training to both users and HCPs can help them use the system effectively.
Collapse
Affiliation(s)
- Jothydev Kesavadev
- Jothydev's Diabetes Research Center, JDC Junction, Mudavanmugal, Trivandrum, Kerala, 695032, India.
| | - Anjana Basanth
- Jothydev's Diabetes Research Center, JDC Junction, Mudavanmugal, Trivandrum, Kerala, 695032, India
| | - Gopika Krishnan
- Jothydev's Diabetes Research Center, JDC Junction, Mudavanmugal, Trivandrum, Kerala, 695032, India
| | - Arun Shankar
- Jothydev's Diabetes Research Center, JDC Junction, Mudavanmugal, Trivandrum, Kerala, 695032, India
| | - Geethu Sanal
- Jothydev's Diabetes Research Center, JDC Junction, Mudavanmugal, Trivandrum, Kerala, 695032, India
| | - Sunitha Jothydev
- Jothydev's Diabetes Research Center, JDC Junction, Mudavanmugal, Trivandrum, Kerala, 695032, India
| |
Collapse
|
23
|
Bassi M, Franzone D, Dufour F, Strati MF, Scalas M, Tantari G, Aloi C, Salina A, d’Annunzio G, Maghnie M, Minuto N. Automated Insulin Delivery (AID) Systems: Use and Efficacy in Children and Adults with Type 1 Diabetes and Other Forms of Diabetes in Europe in Early 2023. Life (Basel) 2023; 13:783. [PMID: 36983941 PMCID: PMC10053516 DOI: 10.3390/life13030783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/07/2023] [Accepted: 03/10/2023] [Indexed: 03/17/2023] Open
Abstract
Type 1 diabetes (T1D) patients' lifestyle and prognosis has remarkably changed over the years, especially after the introduction of insulin pumps, in particular advanced hybrid closed loop systems (AHCL). Emerging data in literature continuously confirm the improvement of glycemic control thanks to the technological evolution taking place in this disease. As stated in previous literature, T1D patients are seen to be more satisfied thanks to the use of these devices that ameliorate not only their health but their daily life routine as well. Limited findings regarding the use of new devices in different age groups and types of patients is their major limit. This review aims to highlight the main characteristics of each Automated Insulin Delivery (AID) system available for patients affected by Type 1 Diabetes Mellitus. Our main goal was to particularly focus on these systems' efficacy and use in different age groups and populations (i.e., children, pregnant women). Recent studies are emerging that demonstrate their efficacy and safety in younger patients and other forms of diabetes.
Collapse
Affiliation(s)
- Marta Bassi
- IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16126 Genoa, Italy
| | - Daniele Franzone
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16126 Genoa, Italy
| | - Francesca Dufour
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16126 Genoa, Italy
| | - Marina Francesca Strati
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16126 Genoa, Italy
| | - Marta Scalas
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16126 Genoa, Italy
| | - Giacomo Tantari
- IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16126 Genoa, Italy
| | - Concetta Aloi
- LABSIEM (Laboratory for the Study of Inborn Errors of Metabolism), Pediatric Clinic, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Alessandro Salina
- LABSIEM (Laboratory for the Study of Inborn Errors of Metabolism), Pediatric Clinic, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | | | - Mohamad Maghnie
- IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16126 Genoa, Italy
| | | |
Collapse
|
24
|
Phillip M, Nimri R, Bergenstal RM, Barnard-Kelly K, Danne T, Hovorka R, Kovatchev BP, Messer LH, Parkin CG, Ambler-Osborn L, Amiel SA, Bally L, Beck RW, Biester S, Biester T, Blanchette JE, Bosi E, Boughton CK, Breton MD, Brown SA, Buckingham BA, Cai A, Carlson AL, Castle JR, Choudhary P, Close KL, Cobelli C, Criego AB, Davis E, de Beaufort C, de Bock MI, DeSalvo DJ, DeVries JH, Dovc K, Doyle FJ, Ekhlaspour L, Shvalb NF, Forlenza GP, Gallen G, Garg SK, Gershenoff DC, Gonder-Frederick LA, Haidar A, Hartnell S, Heinemann L, Heller S, Hirsch IB, Hood KK, Isaacs D, Klonoff DC, Kordonouri O, Kowalski A, Laffel L, Lawton J, Lal RA, Leelarathna L, Maahs DM, Murphy HR, Nørgaard K, O’Neal D, Oser S, Oser T, Renard E, Riddell MC, Rodbard D, Russell SJ, Schatz DA, Shah VN, Sherr JL, Simonson GD, Wadwa RP, Ward C, Weinzimer SA, Wilmot EG, Battelino T. Consensus Recommendations for the Use of Automated Insulin Delivery Technologies in Clinical Practice. Endocr Rev 2023; 44:254-280. [PMID: 36066457 PMCID: PMC9985411 DOI: 10.1210/endrev/bnac022] [Citation(s) in RCA: 97] [Impact Index Per Article: 97.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/22/2022] [Indexed: 02/06/2023]
Abstract
The significant and growing global prevalence of diabetes continues to challenge people with diabetes (PwD), healthcare providers, and payers. While maintaining near-normal glucose levels has been shown to prevent or delay the progression of the long-term complications of diabetes, a significant proportion of PwD are not attaining their glycemic goals. During the past 6 years, we have seen tremendous advances in automated insulin delivery (AID) technologies. Numerous randomized controlled trials and real-world studies have shown that the use of AID systems is safe and effective in helping PwD achieve their long-term glycemic goals while reducing hypoglycemia risk. Thus, AID systems have recently become an integral part of diabetes management. However, recommendations for using AID systems in clinical settings have been lacking. Such guided recommendations are critical for AID success and acceptance. All clinicians working with PwD need to become familiar with the available systems in order to eliminate disparities in diabetes quality of care. This report provides much-needed guidance for clinicians who are interested in utilizing AIDs and presents a comprehensive listing of the evidence payers should consider when determining eligibility criteria for AID insurance coverage.
Collapse
Affiliation(s)
- Moshe Phillip
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children’s Medical Center of Israel, 49202 Petah Tikva, Israel
- Sacker Faculty of Medicine, Tel-Aviv University, 39040 Tel-Aviv, Israel
| | - Revital Nimri
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children’s Medical Center of Israel, 49202 Petah Tikva, Israel
- Sacker Faculty of Medicine, Tel-Aviv University, 39040 Tel-Aviv, Israel
| | - Richard M Bergenstal
- International Diabetes Center, HealthPartners Institute, Minneapolis, MN 55416, USA
| | | | - Thomas Danne
- AUF DER BULT, Diabetes-Center for Children and Adolescents, Endocrinology and General Paediatrics, Hannover, Germany
| | - Roman Hovorka
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Boris P Kovatchev
- Center for Diabetes Technology, School of Medicine, University of Virginia, Charlottesville, VA 22903, USA
| | - Laurel H Messer
- Barbara Davis Center for Diabetes, University of Colorado Denver—Anschutz Medical Campus, Aurora, CO 80045, USA
| | | | | | | | - Lia Bally
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Roy W Beck
- Jaeb Center for Health Research Foundation, Inc., Tampa, FL 33647, USA
| | - Sarah Biester
- AUF DER BULT, Diabetes-Center for Children and Adolescents, Endocrinology and General Paediatrics, Hannover, Germany
| | - Torben Biester
- AUF DER BULT, Diabetes-Center for Children and Adolescents, Endocrinology and General Paediatrics, Hannover, Germany
| | - Julia E Blanchette
- College of Nursing, University of Utah, Salt Lake City, UT 84112, USA
- Center for Diabetes and Obesity, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Emanuele Bosi
- Diabetes Research Institute, IRCCS San Raffaele Hospital and San Raffaele Vita Salute University, Milan, Italy
| | - Charlotte K Boughton
- Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke’s Hospital, University of Cambridge Metabolic Research Laboratories, Cambridge, UK
| | - Marc D Breton
- Center for Diabetes Technology, School of Medicine, University of Virginia, Charlottesville, VA 22903, USA
| | - Sue A Brown
- Center for Diabetes Technology, School of Medicine, University of Virginia, Charlottesville, VA 22903, USA
- Division of Endocrinology, University of Virginia, Charlottesville, VA 22903, USA
| | - Bruce A Buckingham
- Division of Endocrinology, Department of Pediatrics, Stanford University, School of Medicine, Stanford, CA 94304, USA
| | - Albert Cai
- The diaTribe Foundation/Close Concerns, San Diego, CA 94117, USA
| | - Anders L Carlson
- International Diabetes Center, HealthPartners Institute, Minneapolis, MN 55416, USA
| | - Jessica R Castle
- Harold Schnitzer Diabetes Health Center, Oregon Health & Science University, Portland, OR 97239, USA
| | - Pratik Choudhary
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Kelly L Close
- The diaTribe Foundation/Close Concerns, San Diego, CA 94117, USA
| | - Claudio Cobelli
- Department of Woman and Child’s Health, University of Padova, Padova, Italy
| | - Amy B Criego
- International Diabetes Center, HealthPartners Institute, Minneapolis, MN 55416, USA
| | - Elizabeth Davis
- Telethon Kids Institute, University of Western Australia, Perth Children’s Hospital, Perth, Australia
| | - Carine de Beaufort
- Diabetes & Endocrine Care Clinique Pédiatrique DECCP/Centre Hospitalier Luxembourg, and Faculty of Sciences, Technology and Medicine, University of Luxembourg, Esch sur Alzette, GD Luxembourg/Department of Paediatrics, UZ-VUB, Brussels, Belgium
| | - Martin I de Bock
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Daniel J DeSalvo
- Division of Pediatric Diabetes and Endocrinology, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX 77598, USA
| | - J Hans DeVries
- Amsterdam UMC, University of Amsterdam, Internal Medicine, Amsterdam, The Netherlands
| | - Klemen Dovc
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, UMC - University Children’s Hospital, Ljubljana, Slovenia, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Francis J Doyle
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138, USA
| | - Laya Ekhlaspour
- Lucile Packard Children’s Hospital—Pediatric Endocrinology, Stanford University School of Medicine, Palo Alto, CA 94304, USA
| | - Naama Fisch Shvalb
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children’s Medical Center of Israel, 49202 Petah Tikva, Israel
| | - Gregory P Forlenza
- Barbara Davis Center for Diabetes, University of Colorado Denver—Anschutz Medical Campus, Aurora, CO 80045, USA
| | | | - Satish K Garg
- Barbara Davis Center for Diabetes, University of Colorado Denver—Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Dana C Gershenoff
- International Diabetes Center, HealthPartners Institute, Minneapolis, MN 55416, USA
| | - Linda A Gonder-Frederick
- Center for Diabetes Technology, School of Medicine, University of Virginia, Charlottesville, VA 22903, USA
| | - Ahmad Haidar
- Department of Biomedical Engineering, McGill University, Montreal, Canada
| | - Sara Hartnell
- Wolfson Diabetes and Endocrine Clinic, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Simon Heller
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Irl B Hirsch
- Department of Medicine, University of Washington Diabetes Institute, University of Washington, Seattle, WA, USA
| | - Korey K Hood
- Stanford Diabetes Research Center, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Diana Isaacs
- Cleveland Clinic, Endocrinology and Metabolism Institute, Cleveland, OH 44106, USA
| | - David C Klonoff
- Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA 94010, USA
| | - Olga Kordonouri
- AUF DER BULT, Diabetes-Center for Children and Adolescents, Endocrinology and General Paediatrics, Hannover, Germany
| | | | - Lori Laffel
- Joslin Diabetes Center, Harvard Medical School, Boston, MA 02215, USA
| | - Julia Lawton
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Rayhan A Lal
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Lalantha Leelarathna
- Manchester University Hospitals NHS Foundation Trust/University of Manchester, Manchester, UK
| | - David M Maahs
- Division of Endocrinology, Department of Pediatrics, Stanford University, School of Medicine, Stanford, CA 94304, USA
| | - Helen R Murphy
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Kirsten Nørgaard
- Steno Diabetes Center Copenhagen and Department of Clinical Medicine, University of Copenhagen, Gentofte, Denmark
| | - David O’Neal
- Department of Medicine and Department of Endocrinology, St Vincent’s Hospital Melbourne, University of Melbourne, Melbourne, Australia
| | - Sean Oser
- Department of Family Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Tamara Oser
- Department of Family Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Eric Renard
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, and Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Michael C Riddell
- School of Kinesiology & Health Science, Muscle Health Research Centre, York University, Toronto, Canada
| | - David Rodbard
- Biomedical Informatics Consultants LLC, Potomac, MD, USA
| | - Steven J Russell
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Desmond A Schatz
- Department of Pediatrics, College of Medicine, Diabetes Institute, University of Florida, Gainesville, FL 02114, USA
| | - Viral N Shah
- Barbara Davis Center for Diabetes, University of Colorado Denver—Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Jennifer L Sherr
- Department of Pediatrics, Yale University School of Medicine, Pediatric Endocrinology, New Haven, CT 06511, USA
| | - Gregg D Simonson
- International Diabetes Center, HealthPartners Institute, Minneapolis, MN 55416, USA
| | - R Paul Wadwa
- Barbara Davis Center for Diabetes, University of Colorado Denver—Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Candice Ward
- Institute of Metabolic Science, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Stuart A Weinzimer
- Department of Pediatrics, Yale University School of Medicine, Pediatric Endocrinology, New Haven, CT 06511, USA
| | - Emma G Wilmot
- Department of Diabetes & Endocrinology, University Hospitals of Derby and Burton NHS Trust, Derby, UK
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, England, UK
| | - Tadej Battelino
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, UMC - University Children’s Hospital, Ljubljana, Slovenia, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
25
|
Amuedo S, Bellido V, Mangas Cruz MÁ, Gros Herguido N, López Gallardo G, Pérez Morales A, Soto Moreno A. Successful Use of an Advanced Hybrid Closed-loop System in a Patient With Type 3c Pancreatogenic Diabetes Secondary to Nesidioblastosis. Can J Diabetes 2023; 47:193-196. [PMID: 36207270 DOI: 10.1016/j.jcjd.2022.09.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 08/22/2022] [Accepted: 09/12/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Sandra Amuedo
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Virginia Bellido
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain; Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain.
| | - Miguel Ángel Mangas Cruz
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain; Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Noelia Gros Herguido
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain; Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Gema López Gallardo
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Ana Pérez Morales
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Alfonso Soto Moreno
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain; Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain; Facultad de Medicina, Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain
| |
Collapse
|
26
|
Petrovski G, Campbell J, Pasha M, Day E, Hussain K, Khalifa A, van den Heuvel T. Simplified Meal Announcement Versus Precise Carbohydrate Counting in Adolescents With Type 1 Diabetes Using the MiniMed 780G Advanced Hybrid Closed Loop System: A Randomized Controlled Trial Comparing Glucose Control. Diabetes Care 2023; 46:544-550. [PMID: 36598841 PMCID: PMC10148675 DOI: 10.2337/dc22-1692] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/03/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE We aimed to compare glucose control in adolescents with type 1 diabetes (T1D) using the MiniMed 780G system who used simplified meal announcement with those who used precise carbohydrate counting. RESEARCH DESIGN AND METHODS This randomized controlled trial included 34 participants (age 12-18 years) with T1D who were on multiple daily injections or insulin pump and were scheduled to start using the MiniMed 780G system at Sidra Medicine in Qatar. After a 7-day run-in period, participants were randomly assigned to the fix group (simplified meal announcement by preset of three personalized fixed carbohydrate amounts) or the flex group (precise carbohydrate counting) and followed for 12 weeks. Between-group difference in time in range (TIR) was the primary end point. Secondary end points included HbA1c and other glycometrics. RESULTS During the 12-week study phase, TIR was 73.5 ± 6.7% in the fix and 80.3 ± 7.4% in the flex group, with a between-group difference of 6.8% in favor of flex (P = 0.043). Time >250 mg/dL was better in the flex group (P = 0.012), whereas HbA1c (P = 0.168), time below range (P = 0.283), and time between 180 and 250 mg/dL (P = 0.114) did not differ. CONCLUSIONS Adolescents using the MiniMed 780G system with a preset of three personalized fixed carbohydrate amounts can reach international targets of glycemic control. Therefore, it may be a valuable alternative to precise carbohydrate counting in users who are challenged by precise carbohydrate counting. Because carbohydrate counting further improves outcomes, these skills remain important for MiniMed 780G users.
Collapse
Affiliation(s)
- Goran Petrovski
- 1Division of Endocrinology and Diabetes, Sidra Medicine, Doha, Qatar
| | - Judith Campbell
- 1Division of Endocrinology and Diabetes, Sidra Medicine, Doha, Qatar
| | - Maheen Pasha
- 1Division of Endocrinology and Diabetes, Sidra Medicine, Doha, Qatar
| | - Emma Day
- 1Division of Endocrinology and Diabetes, Sidra Medicine, Doha, Qatar
| | - Khalid Hussain
- 1Division of Endocrinology and Diabetes, Sidra Medicine, Doha, Qatar
| | - Amel Khalifa
- 1Division of Endocrinology and Diabetes, Sidra Medicine, Doha, Qatar
| | | |
Collapse
|
27
|
Grassi B, Gómez AM, Calliari LE, Franco D, Raggio M, Riera F, Castro M, McVean J, van den Heuvel T, Arrieta A, Castañeda J, Cohen O. Real-world performance of the MiniMed 780G advanced hybrid closed loop system in Latin America: Substantial improvement in glycaemic control with each technology iteration of the MiniMed automated insulin delivery system. Diabetes Obes Metab 2023; 25:1688-1697. [PMID: 36789699 DOI: 10.1111/dom.15023] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/06/2023] [Accepted: 02/12/2023] [Indexed: 02/16/2023]
Abstract
AIM We studied real-world performance of MiniMed (MM) 780G system users from Argentina, Brazil, Colombia and Chile (geographical analysis), and the effect of each technology iteration of the MM system on glycaemic control (technology iteration analysis). MATERIALS AND METHODS CareLink data from August 2020 to September 2022 were extracted. Endpoints included continuous glucose monitoring metrics. For the geographical analysis, aggregated endpoints for MM780G system users were calculated. For the technology iteration analysis, MM780G system user outcomes were compared with outcomes when the same individuals were still using the MM640G or MM670G system. RESULTS On average, 1025 MM780G system users from the geographical analysis were followed for 136 (SD 135) days, spent 91.5 (14.3)% in advanced hybrid closed loop, showed a glucose management indicator (GMI) of 6.7 (0.3)%, a time in range between 70 and 180 mg/dl (TIR) of 76.5 (9.0)%, and a time below range 70 mg/dl (TBR) of 2.7 (2.1)%. The percentage of users reaching targets of GMI <7%, TIR >70% and TBR <4% was 80.8%, 78.1% and 80.1%, respectively. The technology iteration analysis on users transitioning from MM640G to MM780G system (N = 381) showed 0.4% decrease in GMI (7.1% to 6.7%, p < .0001), 10.7% increase in TIR (65.9% to 76.6%, p < .0001), while TBR remained. The percentage of insulin delivered automatically increased as well (47.5%-57.7%, p < .0001). Users transitioning from MM670G system (N = 78) showed a similar but less pronounced pattern. CONCLUSIONS Real-world Latin American MM780G users on average showed good glucose control, achieving international targets. Glycaemic control increased with every technology iteration of the MM system, providing more automation each time.
Collapse
Affiliation(s)
- Bruno Grassi
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ana Maria Gómez
- Pontificia Universidad Javeriana, Bogotá, Colombia
- Hospital Universitario de San Ignacio, Bogotá, Colombia
| | | | - Denise Franco
- CPCLIN/DASA Clinical Research Centre, São Paulo, Brazil
| | | | | | | | | | | | - Arcelia Arrieta
- Medtronic International Trading Sarl, Tolochenaz, Switzerland
| | | | - Ohad Cohen
- Medtronic International Trading Sarl, Tolochenaz, Switzerland
| |
Collapse
|
28
|
Benhamou PY, Adenis A, Lebbad H, Tourki Y, Heredia MB, Gehr B, Franc S, Charpentier G. One-year real-world performance of the DBLG1 closed-loop system: Data from 3706 adult users with type 1 diabetes in Germany. Diabetes Obes Metab 2023; 25:1607-1613. [PMID: 36751978 DOI: 10.1111/dom.15008] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/27/2023] [Accepted: 02/04/2023] [Indexed: 02/09/2023]
Abstract
AIM The Diabeloop Generation 1 (DBLG1) system is an interoperable hybrid closed-loop solution that was commercialized in Germany in March 2021. We report the longitudinal glycaemic outcomes among the first 3706 users in a real-world setting. METHODS We performed a retrospective data collection of all consenting adult patients with type 1 diabetes who were equipped in Germany with the DBLG1 system before 30 April 2022, and with a minimum 14 days of closed-loop usage. RESULTS In total, 3706 users (41% women, age 45.1 ± 14.5 years) met the inclusion criteria, reaching a mean follow-up of 131.0 ± 85.1 days, an overall 485 600 days of continuous glucose monitoring data, and a median time spent in closed-loop of 95.0% (IQR 89.1-97.4). The median percentage time in range (70-180 mg/dl) was 72.1% (IQR 65.0-78.9); the time below 70 mg/dl was 0.9% (0.5-1.7), the time below 54 mg/dl was 0.1% (0.1-0.3), and the median Glucose Management Index was 7.0% (6.8-7.3). Exploratory analysis of a subset of 2460 patients in whom baseline glycated haemoglobin (HbA1c) was available [7.4% (IQR 6.9-8.0)] showed that the achieved mean time in range was influenced by baseline HbA1c, ranging from 65.8 ± 9.9% (A1c ≥8.5%) to 81.3 ± 6.8% (A1c <6.5%). CONCLUSION This large real-world analysis confirms the relevance of the DBLG1 automated insulin delivery solution for the achievement of standards of care in adult patients with type 1 diabetes.
Collapse
Affiliation(s)
- Pierre-Yves Benhamou
- Department of Endocrinology, Grenoble University Hospital, Grenoble Alpes University, INSERM U1055, LBFA, Grenoble, France
| | | | | | | | | | - Bernhard Gehr
- Zentrum für Diabetes und Stoffwechselerkrankungen, m&i Fachklinik Bad Heilbrunn, Bad Heilbrunn, Germany
| | - Sylvia Franc
- CERITD (Center for Study and Research for Improvement of the Treatment of Diabetes), Bioparc-Genopole Evry-Corbeil, Evry, France
- Department of Diabetes and Endocrinology, Sud-Francilien Hospital, Corbeil, France
| | - Guillaume Charpentier
- CERITD (Center for Study and Research for Improvement of the Treatment of Diabetes), Bioparc-Genopole Evry-Corbeil, Evry, France
- Department of Diabetes and Endocrinology, Sud-Francilien Hospital, Corbeil, France
| |
Collapse
|
29
|
Messer LH, Addala A, Weinzimer SA. Real-World Diabetes Technology: Overcoming Barriers and Disparities. Diabetes Technol Ther 2023; 25:S176-S190. [PMID: 36802191 DOI: 10.1089/dia.2023.2511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- Laurel H Messer
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ananta Addala
- Division of Pediatric Endocrinology & Diabetes, Department of Pediatrics, Stanford University, Palo Alto, CA, USA
| | - Stuart A Weinzimer
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| |
Collapse
|
30
|
Quirós C, Alonso-Carril N, Rodríguez-Rodríguez S, Barahona MJ, Orois A, Simó-Servat A, Ramos M, Perea V. The Medtronic 780G advanced hybrid closed-loop system achieves and maintains good glycaemic control in type 1 diabetes adults despite previous treatment. ENDOCRINOL DIAB NUTR 2023; 70:130-135. [PMID: 36925230 DOI: 10.1016/j.endien.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/17/2022] [Indexed: 03/18/2023]
Abstract
INTRODUCTION Improvements in continuous glucose monitoring (CGM) in recent years have changed the treatment of type 1 diabetes (T1D) by permitting the automation of glucose control. The Minimed 780G advanced hybrid closed-loop (ACHL) system adapts basal infusion rates and delivers auto-correction boluses in order to achieve a user-decided glucose target (100, 110 or 120mg/dL). This study set out to evaluate the effectiveness of the Medtronic 780G system in real-life conditions over 6 months. MATERIALS AND METHODS Prospective study that included T1D subjects previously treated with insulin pump without CGM (pump group) or with sensor-augmented pump with predictive low-glucose suspend (SAP-PLGS group) who started with the Minimed 780G system. Sensor and pump data from baseline, and at 1, 3 and 6 months were downloaded and HbA1c was recorded at baseline and at 6 months. RESULTS Fifty T1D subjects were included; 25 were previous SAP-PLGS 640G users and 25 used 640G without CGM. 66% were female, 48.6 (40-57) years of age with 20 (12-31.5) years of diabetes duration. Time in range (TIR) improved in the total cohort from baseline to 6 months (69% (57.7-76) vs. 74% (70-82); p=0.01 as did HbA1c (7.6% (7.1-7.8) vs. 7.0% (6.8-7.5); p<0.001), with improvement in times <54, >180 and >250mg/dL. Outcomes at 6 months did not differ between groups, although the SAP-PLGS subjects were prone to hypoglycaemia and the pump group mainly presented suboptimal metabolic control. CONCLUSION The AHCL Medtronic Minimed 780G system achieves and maintains good glycaemic control over 6 months in real-life conditions in different profiles of T1D subjects.
Collapse
Affiliation(s)
- Carmen Quirós
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Spain.
| | - Nuria Alonso-Carril
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Spain
| | | | - Maria-José Barahona
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Spain
| | - Aida Orois
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Spain
| | - Andreu Simó-Servat
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Spain
| | - Montserrat Ramos
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Spain
| | - Verónica Perea
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Spain
| |
Collapse
|
31
|
Gros Herguido N, Amuedo S, Bellido V, López Gallardo G, Losada F, Pérez Morales A, Ruiz Trillo CA, Soto Moreno A. Effectiveness and Safety of an Advanced Hybrid Closed-Loop System in Adolescents and Adults with Type 1 Diabetes Previously Treated with Continuous Subcutaneous Insulin Infusion and Flash Glucose Monitoring. Diabetes Technol Ther 2023; 25:151-156. [PMID: 36108305 DOI: 10.1089/dia.2022.0287] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This study aimed to evaluate the effectiveness and safety of the MiniMed™ 780G advanced hybrid closed-loop (AHCL) system in people with type 1 diabetes (T1D) previously treated with continuous subcutaneous insulin infusion combined with flash glucose monitoring in a real-life setting. A total of 47 subjects (mean age 41 ± 13.6 years, 60% females, diabetes duration 28 ± 11 years) were included and switched to an AHCL system. Baseline and 6-month data were analyzed. Time in range 70-180 mg/dL increased from 65.3% at baseline to 73.8% at 6 months. Time in hyperglycemia >180 mg/dL decreased from 26.6% to 19.3%. Time in hypoglycemia <70 mg/dL decreased from 4.6% to 2.3%. The coefficient of variation also decreased from 36% to 31.6%. No episodes of severe hypoglycemia, diabetes ketoacidosis, or diabetes-related hospital admissions occurred. In conclusion, the MiniMed 780G AHCL system enables the safe achievement of recommended glycemic targets in people with T1D after 6 months of use.
Collapse
Affiliation(s)
- Noelia Gros Herguido
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Sandra Amuedo
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Virginia Bellido
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Gema López Gallardo
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Fernando Losada
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Ana Pérez Morales
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Carmen Amelia Ruiz Trillo
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Alfonso Soto Moreno
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
- Departamento de Medicina, Facultad de Medicina, Universidad de Sevilla, Sevilla, Spain
| |
Collapse
|
32
|
ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, Collins BS, Hilliard ME, Isaacs D, Johnson EL, Kahan S, Khunti K, Leon J, Lyons SK, Perry ML, Prahalad P, Pratley RE, Seley JJ, Stanton RC, Gabbay RA, on behalf of the American Diabetes Association. 14. Children and Adolescents: Standards of Care in Diabetes-2023. Diabetes Care 2023; 46:S230-S253. [PMID: 36507640 PMCID: PMC9810473 DOI: 10.2337/dc23-s014] [Citation(s) in RCA: 74] [Impact Index Per Article: 74.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
Collapse
|
33
|
Bassi M, Patti L, Silvestrini I, Strati MF, Ponzano M, Minuto N, Maggi D. One-year follow-up comparison of two hybrid closed-loop systems in Italian children and adults with type 1 diabetes. Front Endocrinol (Lausanne) 2023; 14:1099024. [PMID: 36777356 PMCID: PMC9909036 DOI: 10.3389/fendo.2023.1099024] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/16/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND AND AIMS Tandem Control-IQ and MiniMed 780G are the main Advanced Hybrid Closed Loop (AHCL) systems currently available in pediatric and adult patients with Type 1 Diabetes (T1D). The aim of our study was to evaluate glycemic control after 1-year of follow-up extending our previous study of 1-month comparison between the two systems. METHODS We retrospectively compared clinical and continuous glucose monitoring (CGM) data from the patients included in the previous study which have completed 1-year observation period. The study population consisted of 74 patients, 42 Minimed 780G users and 32 Tandem Control-IQ users. Linear mixed models with random intercept were performed to study the variations over time and the interaction between time and system; Mann-Whitney or T-test were used to compare systems at 1-year. RESULTS Both systems have been shown to be effective in maintaining the glycemic improvement achieved one month after starting AHCL. Significant changes over time were observed for TIR, TAR, TAR>250mg/dl, average glucose levels and SD (p<0.001). At 1-year follow-up Minimed 780G obtained better improvement in TIR (p<0.001), TAR (p=0.002), TAR>250mg/dl (p=0.001), average glucose levels (p<0.001). The comparison of the glycemic parameters at 1-year showed a significant superiority of Minimed 780G in terms of TIR (71% vs 68%; p=0.001), TAR (p=0.001), TAR>250 (p=0.009), average glucose levels(p=0.001) and SD (p=0.031). CONCLUSIONS The use of AHCL systems led to a significant improvement of glycemic control at 1-month, which is maintained at 1-year follow-up. MiniMed is more effective than Tandem in reaching the International recommended glycemic targets. Continuous training and education in the use of technology is essential to get the best out of the most advanced technological tools.
Collapse
Affiliation(s)
- Marta Bassi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genoa, Genoa, Italy
| | - Luca Patti
- Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, Genoa, Italy
| | - Irene Silvestrini
- Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, Genoa, Italy
| | - Marina Francesca Strati
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genoa, Genoa, Italy
| | - Marta Ponzano
- Department of Health Science (DiSSAL), University of Genoa, Genoa, Italy
| | - Nicola Minuto
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genoa, Genoa, Italy
- *Correspondence: Nicola Minuto,
| | - Davide Maggi
- Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, Genoa, Italy
- Diabetes Clinic, IRCCS Ospedale Policlinico San Martino Genoa, Genoa, Italy
| |
Collapse
|
34
|
Piccini B, Pessina B, Casalini E, Lenzi L, Toni S. Long-term effectiveness of advanced hybrid closed loop in children and adolescents with type 1 diabetes. Pediatr Diabetes 2022; 23:1647-1655. [PMID: 36317539 DOI: 10.1111/pedi.13440] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/20/2022] [Accepted: 10/22/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Advanced hybrid closed loop (AHCL) systems are the newest tool to improve metabolic control in type 1 diabetes (T1D). Long-term glycemic control of children and adolescents with T1D switching to MiniMed™ 780G in a real clinical setting was evaluated. METHODS Time in range (TIR) and in different glucose ranges, glycemic variability indexes, HbA1c and basal-bolus insulin distribution were evaluated in 44 subjects (mean age 14.2 ± 4.0 years, 22 males) during manual mode period, first 14 days (A14d) and first month after auto-mode activation (A1M), first 14 days after 3 months (A3M) and 6 months (A6M) in auto-mode. RESULTS Mean TIR at A14d was 76.3 ± 9.6% versus 69.3 ± 12.6% in manual mode (p < 0.001), and this improvement was maintained over 6 months. Subjects with TIR >70% and >80% in manual mode were 45% and 23%, respectively, and increased to 80% (p = 0.041) and 41% (p = 0.007) at A14d. Basal-bolus distribution changed in favor of bolus, and auto-correction boluses inversely correlated with TIR. HbA1c was 7.2 ± 0.7% (55 mmol/mol) at baseline and significantly improved after 3 months (6.7 ± 0.5%, 50 mmol/mol, p < 0.001) and 6 months (6.6 ± 0.5%, 49 mmol/mol, p < 0.001). TIR was higher in individuals >13 years at all time periods (p < 0.001). Glycemic target <120 mg/dl was associated with better TIR. CONCLUSIONS AHCL MiniMed™ 780G allowed rapid and sustained improvement of glycemic control in young T1D patients, reaching recommended TIR. Teenagers showed good technology adherence with optimal TIR, maintained better over time compared to younger children. Stricter settings were associated with better metabolic control, without increase in severe hypoglycemia occurrence.
Collapse
Affiliation(s)
- Barbara Piccini
- Diabetology Unit, Meyer University Children's Hospital, Florence, Italy
| | - Benedetta Pessina
- Department of Pediatrics, Meyer University Children's Hospital, University of Florence, Florence, Italy
| | - Emilio Casalini
- Department of Pediatrics, Istituto Giannina Gaslini, University of Genova, Genoa, Italy
| | - Lorenzo Lenzi
- Diabetology Unit, Meyer University Children's Hospital, Florence, Italy
| | - Sonia Toni
- Diabetology Unit, Meyer University Children's Hospital, Florence, Italy
| |
Collapse
|
35
|
Castañeda J, Mathieu C, Aanstoot HJ, Arrieta A, Da Silva J, Shin J, Cohen O. Predictors of time in target glucose range in real-world users of the MiniMed 780G system. Diabetes Obes Metab 2022; 24:2212-2221. [PMID: 35791621 DOI: 10.1111/dom.14807] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/15/2022] [Accepted: 07/01/2022] [Indexed: 11/29/2022]
Abstract
AIM Automated insulin delivery systems have improved glycaemic control in people with type 1 diabetes mellitus. The analysis investigated predictors of improved sensor glucose time-in-range (TIR; 70-180 mg/dl) based on real-world use of the MiniMed 780G advanced hybrid closed-loop (AHCL) system. METHODS Data uploaded by MiniMed 780G system users from August 2020-July 2021 were analysed using univariate and multivariable models to identify baseline, demographic and system use characteristics associated with TIR after AHCL initiation (post-AHCL). System settings associated with improved TIR post-AHCL were identified and their impact on time below range (TBR, <70 mg/dl) post-AHCL was explored. RESULTS In total, 12 870 users were included, of which 2977 had baseline sensor glucose data. Baseline TIR and time in AHCL (defined as the percentage of time the system was in Auto-mode) were positively associated with TIR post-AHCL with larger values predicting greater mean TIR post-AHCL. Characteristics inversely associated with TIR post-AHCL included the percentage of daily basal insulin dose, daily autocorrection dose, number of daily AHCL exits triggered by the system and number of daily alarms, wherein larger values of these characteristics predicted lower mean TIR post-AHCL. System settings that predicted the largest mean TIR post-AHCL were active insulin time of 2 h and glucose target of 100 mg/dl. Active insulin time was not associated with TBR post-AHCL. CONCLUSION Modifiable factors, including optimized pump settings, can allow users to achieve glycaemic targets with >80% TIR. The findings from this analysis will potentially guide the optimal use of the MiniMed 780G system and facilitate meaningful improvements in safe glycaemic control.
Collapse
Affiliation(s)
| | - Chantal Mathieu
- Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium
| | - Henk-Jan Aanstoot
- Diabeter, Center for Diabetes Care and Research, Rotterdam, The Netherlands
| | - Arcelia Arrieta
- Medtronic Bakken Research Center, Maastricht, The Netherlands
| | - Julien Da Silva
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - John Shin
- Medtronic, Northridge, California, USA
| | - Ohad Cohen
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| |
Collapse
|
36
|
Matejko B, Juza A, Kieć-Wilk B, Cyranka K, Krzyżowska S, Chen X, Cohen O, Da Silva J, Malecki MT, Klupa T. Transitioning of People With Type 1 Diabetes From Multiple Daily Injections and Self-Monitoring of Blood Glucose Directly to MiniMed 780G Advanced Hybrid Closed-Loop System: A Two-Center, Randomized, Controlled Study. Diabetes Care 2022; 45:2628-2635. [PMID: 35972259 PMCID: PMC9862281 DOI: 10.2337/dc22-0470] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/25/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the outcomes of transitioning to the MiniMed 780G advanced hybrid closed-loop (AHCL) system in adult individuals with type 1 diabetes mellitus (T1DM) naive to continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) technologies. RESEARCH DESIGN AND METHODS This was a two-center, randomized, controlled, parallel-group trial with evaluation of individuals with T1DM aged 26-60 years managed with multiple daily injections (MDI) and self-monitoring of blood glucose (BGM) with HbA1c <10%. RESULTS A total of 41 participants were recruited and randomized to either the AHCL (n = 20) or the MDI+BGM (n = 21) group, and 37 participants (mean ± SD age 40.3 ± 8.0 years, duration of diabetes 17.3 ± 12.1 years, BMI 25.1 ± 3.1 kg/m2, HbA1c 7.2 ± 1.0%) completed the study. Time spent with glucose levels in target range increased from 69.3 ± 12.3% at baseline to 85.0 ± 6.3% at 3 months in the AHCL group, while remaining unchanged in the control group (treatment effect 21.5% [95% CI 15.7, 27.3]; P < 0.001). The time with levels below range (<70 mg/dL) decreased from 8.7 ± 7.3% to 2.1 ± 1.7% in the AHCL group and remained unchanged in the MDI+BGM group (treatment effect -4.4% [95% CI -7.4, -2.1]; P < 0.001). Participants from the AHCL group also had significant improvements in HbA1c levels (treatment effect -0.6% [95% CI -0.9, -0.2]; P = 0.005) and in quality of life (QoL) in specific subscales compared with the MDI+BGM group. CONCLUSIONS People with T1DM naive to CSII and CGM technologies initiating AHCL significantly and safely improved their glycemic control, as well as their QoL and psychological well-being.
Collapse
Affiliation(s)
- Bartłomiej Matejko
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.,University Hospital in Krakow, Krakow, Poland
| | - Anna Juza
- Clinical Provincial Hospital of Frederic Chopin No. 1 in Rzeszów, Rzeszów, Poland.,College of Medical Sciences, University of Rzeszów, Rzeszów, Poland
| | - Beata Kieć-Wilk
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.,University Hospital in Krakow, Krakow, Poland
| | - Katarzyna Cyranka
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.,University Hospital in Krakow, Krakow, Poland.,Department of Psychiatry, Jagiellonian University Medical College, Krakow, Poland
| | | | | | - Ohad Cohen
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - Julien Da Silva
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - Maciej T Malecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.,University Hospital in Krakow, Krakow, Poland
| | - Tomasz Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.,University Hospital in Krakow, Krakow, Poland
| |
Collapse
|
37
|
Seget S, Rusak E, Polanska J, Jarosz-Chobot P. Prospective Open-Label, Single-Arm, Single-Center Follow-Up Study of the Application of the Advanced Hybrid Closed Loop System in Well-Controlled Children and Adolescents with Type 1 Diabetes. Diabetes Technol Ther 2022; 24:824-831. [PMID: 35852811 PMCID: PMC9618370 DOI: 10.1089/dia.2022.0148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background: The aim of this prospective open-label single-arm single-center follow-up study was to analyze glycemic control in children and adolescents with type 1 diabetes treated with the advanced hybrid closed loop (AHCL) system in relation to a sensor-augmented pump with low-glucose suspend (SAP-LGS) or predictive low-glucose suspend (SAP-PLGS). Materials and Methods: The data for 50 children and adolescents (age 5.5-19.6 years) with type 1 diabetes, receiving insulin through an AHCL system after being switched from SAP-LGS/PLGS systems, were included in the analysis. The SAP-LGS/PLGS records from 2 weeks preceding the AHCL connection were compared with the records from the first 4 weeks of AHCL use, represented as two separate 2-week intervals. Results: Significant improvements in most of the parameters, namely time spent in the range of 70-140 mg/dL (from 53.80% ± 12.35% to 61.70% ± 8.42%, P < 0.001) and 70-180 mg/dL (from 76.17% ± 10.28% to 81.32% ± 7.71%, P < 0.001), average sensor glucose (from 138.61 ± 16.66 to 130.02 ± 10.91 mg/dL, P < 0.001), and glucose management indicator (from 6.54% ± 0.45% to 6.27% ± 0.29%, P = 0.001), were observed within 2 weeks of switching to the AHCL. More evident improvements were observed for the parameters monitored at night than during the day. The potential limitations of this study were the short observation time, lack of glycated hemoglobin measurements, and no control arm. Conclusion: The AHCL system can significantly improve glycemic control even in well-controlled children and adolescents with type 1 diabetes by increasing the proportion of time spent in the narrower range of 70-140 mg/dL and decreasing the mean glucose concentration, especially during the night.
Collapse
Affiliation(s)
- Sebastian Seget
- Department of Children's Diabetology, Medical University of Silesia, Katowice, Poland
| | - Ewa Rusak
- Department of Children's Diabetology, Medical University of Silesia, Katowice, Poland
| | - Joanna Polanska
- Department of Data Science and Engineering, Silesian University of Technology, Gliwice, Poland
- Address correspondence to: Joanna Polanska, PhD, Prof, Department of Data Science and Engineering, Silesian University of Technology, Akademicka 16, 44-100 Gliwice, Poland
| | | |
Collapse
|
38
|
Lepore G, Rossini A, Bellante R, Corsi A, Scaranna C, Dodesini AR, Trevisan R. Switching to the Minimed™ 780G system achieves clinical targets for CGM in adults with type 1 diabetes regardless of previous insulin strategy and baseline glucose control. Acta Diabetol 2022; 59:1309-1315. [PMID: 35857108 DOI: 10.1007/s00592-022-01937-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 06/29/2022] [Indexed: 11/26/2022]
Abstract
AIMS Advanced hybrid closed-loop (AHCL) systems represent the latest introduction in the treatment of type 1 diabetes (T1DM). Randomized controlled trials and real-world evidence studies showed that AHCL systems are a safe and effective insulin management strategy. Aim of this retrospective, single-center, real-life study was to evaluate the effect on metabolic control, evaluated by continuous glucose monitoring (CGM) metrics, of the switch from four available insulin strategies to an AHCL system in adult patients with type 1 diabetes. METHODS A total of 102 patients with T1DM (mean age 42.1 ± 16.3 years, males/females 47/55, duration of diabetes 21.4 ± 13.3 years, BMI 24.4 ± 4.5 kg/m2, HbA1c 59.9 ± 9.6 mmol/mol or 7.6 ± 0.9%), treated with four different insulin therapies [multiple daily insulin (MDI) therapy, continuous subcutaneous insulin infusion (CSII), sensor-augmented pump (SAP) with predictive low-glucose suspend (PLGS), and hybrid closed loop (HCL) system] were evaluated before hand, two months and six months after switching to an AHCL (Minimed™ 780G system, Medtronic, Northridge, CA) system. RESULTS Two months after the switch, mean GCM metrics improved in all four treatment groups. Six months after the switch, the participants of all four groups achieved a mean GMI < 53 mmol/mol, TIR > 70%, TBR < 4%, and CV < 36%, which is recommended by the ADA Standard of Medical Care in Diabetes 2022, including the MDI group with worse baseline glycemic control. CONCLUSIONS Switching to an AHCL leads to a rapid improvement in glycemic control lasting for up to six months independently of previous insulin treatment and baseline conditions.
Collapse
Affiliation(s)
- Giuseppe Lepore
- Unit of Endocrine Diseases and Diabetology, ASST Papa Giovanni XXIII, Bergamo, Italy.
| | - Alessandro Rossini
- Unit of Endocrine Diseases and Diabetology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Rosalia Bellante
- Unit of Endocrine Diseases and Diabetology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Anna Corsi
- Unit of Endocrine Diseases and Diabetology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Cristiana Scaranna
- Unit of Endocrine Diseases and Diabetology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Roberto Trevisan
- Unit of Endocrine Diseases and Diabetology, ASST Papa Giovanni XXIII, Bergamo, Italy
- Department of Medicine, University of Milano Bicocca, Milan, Italy
| |
Collapse
|
39
|
Choudhary P, Kolassa R, Keuthage W, Kroeger J, Thivolet C, Evans M, Ré R, de Portu S, Vorrink L, Shin J, Habteab A, Castañeda J, da Silva J, Cohen O. Advanced hybrid closed loop therapy versus conventional treatment in adults with type 1 diabetes (ADAPT): a randomised controlled study. Lancet Diabetes Endocrinol 2022; 10:720-731. [PMID: 36058207 DOI: 10.1016/s2213-8587(22)00212-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/29/2022] [Accepted: 07/07/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Adults with type 1 diabetes who are treated with multiple daily injections of insulin plus intermittently scanned continuous glucose monitoring (isCGM) can have suboptimal glucose control. We aimed to assess the efficacy of an advanced hybrid closed loop (AHCL) system compared with such therapy in this population. METHODS The Advanced Hybrid Closed Loop Study in Adult Population with Type 1 Diabetes (ADAPT) trial is a prospective, multicentre, open-label, randomised controlled trial that involved 14 centres in three European countries (France, Germany, and the UK). We enrolled patients who were at least 18 years of age, had a type 1 diabetes duration of at least 2 years, HbA1c of at least 8% (64 mmol/mol), and were using multiple daily injections of insulin plus isCGM (cohort A) or real time continuous glucose monitoring (cohort B) for at least 3 months. Here, only results for cohort A are reported. Participants were randomly allocated 1:1 to AHCL therapy or continuation of multiple daily injections of insulin plus continuous glucose monitoring for 6 months with an investigator-blinded block randomisation procedure. Participants and treating clinicians could not be masked to the arm assignment. The primary endpoint was the between-group difference in mean HbA1c change from baseline to 6 months in the intention-to-treat population using AHCL therapy and those using multiple daily injections of insulin plus isCGM. The primary endpoint was analysed using a repeated measures random-effects model with the study arm and period as factors. Safety endpoints included the number of device deficiencies, severe hypoglycaemic events, diabetic ketoacidosis, and serious adverse events. This study is registered with ClinicalTrials.gov, NCT04235504. FINDINGS Between July 13, 2020, and March 12, 2021, 105 people were screened and 82 randomly assigned to treatment (41 in each arm). At 6 months, mean HbA1c had decreased by 1·54% (SD 0·73), from 9·00% to 7·32% in the AHCL group and 0·20% (0·80) in the multiple daily injections of insulin plus isCGM from 9·07% to 8·91% (model-based difference -1·42%, 95% CI -1·74 to -1·10; p<0·0001). No diabetic ketoacidosis, severe hypoglycaemia, or serious adverse events related to study devices occurred in either group; two severe hypoglycaemic events occurred in the run-in phase. 15 device-related non-serious adverse events occurred in the AHCL group, compared with three in the multiple daily injections of insulin plus isCGM group. Two serious adverse events occurred (one in each group), these were breast cancer (in one patient in the AHCL group) and intravitreous haemorrhage (in one patient in the multiple daily injections of insulin plus isCGM group). INTERPRETATION In people with type 1 diabetes using multiple daily injections of insulin plus isCGM and with HbA1c of at least 8%, the use of AHCL confers benefits in terms of glycaemic control beyond those that can be achieved with multiple daily injections of insulin plus isCGM. These data support wider access to AHCL in people with type 1 diabetes not at target glucose levels. FUNDING Medtronic International Trading Sàrl.
Collapse
Affiliation(s)
- Pratik Choudhary
- Kings College Hospital NHS Foundation Trust, London, UK; Leicester Diabetes Centre, University of Leicester, Leicester, UK
| | - Ralf Kolassa
- Diabetologische Schwerpunktpraxis, Bergheim, Germany
| | - Winfried Keuthage
- Schwerpunktpraxis für Diabetes und Ernährungsmedizin, Münster, Germany
| | - Jens Kroeger
- Zentrum für Diabetologie Bergedorf, Hamburg, Germany
| | | | - Mark Evans
- Wellcome Trust-MRC Institute of Metabolic Science and Department of Medicine, University of Cambridge, Cambridge, UK
| | - Roseline Ré
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - Simona de Portu
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - Linda Vorrink
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - John Shin
- Medtronic, Northridge, California, USA
| | - Aklilu Habteab
- Medtronic Bakken Research Center, Maastricht, Netherlands
| | | | - Julien da Silva
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - Ohad Cohen
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland.
| | | |
Collapse
|
40
|
Elbarbary NS, Ismail EAR. Glycemic control during Ramadan fasting in adolescents and young adults with type 1 diabetes on MiniMed™ 780G advanced hybrid closed‑loop system: A randomized controlled trial. Diabetes Res Clin Pract 2022; 191:110045. [PMID: 35987309 DOI: 10.1016/j.diabres.2022.110045] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/05/2022] [Accepted: 08/15/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND MiniMedTM 780G is the most advanced insulin pump system approved for the treatment of type 1 diabetes mellitus (T1DM). Hypoglycemic events are a serious complication associated with T1DM management during Ramadan fasting. AIM This prospective study assessed the safety, effectiveness and optimization of advanced hybrid closed loop (AHCL) system on glycemic metrics and the level of hypoglycemia in T1DM patients who wished to fast Ramadan. METHODS Forty-two T1DM patients (mean age 15.2 ± 3.4 years) using AHCL system were divided into two groups (each n = 21): intervention group who adjusted AHCL settings and control group who kept the same settings as before Ramadan. RESULTS The most aggressive system settings among control group consisting of a 100 mg/dL glucose target, active insulin time of 2 h and bolus increment,maintained exceptional glycemia withtime in range reaching82.0 ± 10.2%, time above range >180 mg/dL of 12.1 ± 3.5% without an increase in hypoglycemia (time below range 3.0 ± 0.3%). All of which were non-significant in comparison to the intervention group. Overall time spent in closed loop (SmartGuard) by users averaged 98.7 ± 2.1% in Auto Mode and involved only 1.0 ± 0.7 exits per week indicating confidence in the system's performance. There were no severe hypoglycemic or diabetic ketoacidosis events during the study. CONCLUSIONS MiniMed™ 780G AHCL system assist in safe fasting with minimal user input and allows for achievement of recommended glycemic targets in people with T1DM during Ramadan fasting. The system demonstrated reduction in hypoglycemia exposure without compromising safety.
Collapse
|
41
|
Beato-Víbora PI, Ambrojo-López A, Fernández-Bueso M, Gil-Poch E, Javier Arroyo-Díez F. Long-term outcomes of an advanced hybrid closed-loop system: A focus on different subpopulations. Diabetes Res Clin Pract 2022; 191:110052. [PMID: 36030902 DOI: 10.1016/j.diabres.2022.110052] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/18/2022] [Accepted: 08/22/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND The long-term benefit provided by advanced hybrid closed-loop (AHCL) systems needs to be assessed in general populations and specific subpopulations. METHODS A prospective evaluation of subjects initiating the AHCL system 780G was performed. Time in range (70-180 mg/dl) (TIR), <70 mg/dl, <54 mg/dl, >180 mg/dl and >250 mg/dl were compared, at baseline and after one year, in different subpopulations, according to previous treatment (pump vs MDI), age (> or ≤25 years old) and hypoglycaemia risk at baseline. RESULTS 135 subjects were included (age: 35 ± 15 years, 64 % females, diabetes duration: 21 ± 12 years). An increase in TIR was found, from 67.26 ± 11.80 % at baseline to 77.41 ± 8.85 % after one year (p < 0.001). All the subgroups showed a significant improvement in TIR, time > 180 mg/dl and >250 mg/dl. At the 1-year evaluation, no significant differences were found, between previous pump users and MDI subjects. Children and young adults had a lower time < 70 mg/dl than adults. Subjects with a high risk of hypoglycaemia at baseline had a higher time spent at <70 mg/dl and <54 mg/dl than low-risk individuals. CONCLUSION The initial benefit provided by the AHCL system is sustained in the long term. MDI subjects obtain the same outcomes as subjects with pump experience.
Collapse
Affiliation(s)
- Pilar Isabel Beato-Víbora
- Diabetes Technology Unit, Endocrinology and Nutrition Department, Badajoz University Hospital, Badajoz, Spain.
| | - Ana Ambrojo-López
- Diabetes Technology Unit, Endocrinology and Nutrition Department, Badajoz University Hospital, Badajoz, Spain
| | - Mercedes Fernández-Bueso
- Diabetes Technology Unit, Endocrinology and Nutrition Department, Badajoz University Hospital, Badajoz, Spain
| | - Estela Gil-Poch
- Diabetes Technology Unit, Department of Paediatrics, Badajoz University Hospital, Badajoz, Spain
| | | |
Collapse
|
42
|
Schiaffini R, Deodati A, Nicoletti MC, Carducci C, Ciampalini P, Lorubbio A, Matteoli MC, Pampanini V, Patera IP, Rapini N, Cianfarani S. Comparison of two advanced hybrid closed loop in a pediatric population with type 1 diabetes: a real-life observational study. Acta Diabetol 2022; 59:959-964. [PMID: 35451679 DOI: 10.1007/s00592-022-01886-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/28/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The Advanced Hybrid Closed Loop (AHCL) systems have provided the potential to ameliorate glucose control in children with Type 1 Diabetes. The aim of the present work was to compare metabolic control obtained with 2 AHCL systems (Medtronic 780G system and Tandem Control IQ system) in a pediatric real-life clinical context. RESEARCH DESIGN AND METHODS It is an observational, real-life, monocentric study; thirty one children and adolescents (M:F = 15:16, age range 7.6-18 years, mean age 13.05 ± 2.4 years, Diabetes duration > 1 year) with T1D, previously treated with Predictive Low Glucose Suspend (PLGS) systems and then upgraded to AHCL have been enrolled. CGM data of the last four weeks of "PLGS system" (PRE period) with the first four weeks of AHCL system (POST period) have been compared. RESULTS For both AHCL systems, Medtronic 780G and Tandem Control IQ, respectively TIR at 4 weeks significantly increased, from 65.7 to 70.5% (p < 0.01) and from 64.8 to 70.1% (p < 0.01). (p < 0.01). The comparison between CGM metrics of the 2 evaluated systems doesn't show difference at baseline (last four weeks of PLGS system) and after four weeks of AHCL use. CONCLUSIONS To our knowledge, this study is the first real-life one comparing 2 AHCL systems in a pediatric population with T1D. It shows an improvement in glucose control when upgrading to AHCL. The comparison between the two AHCL systems did not show significant differences in the analyzed CGM metrics, meaning that the algorithms currently available are equally effective in promoting glucose control.
Collapse
Affiliation(s)
- R Schiaffini
- Diabetes Unit, Bambino Gesù Children's Hospital, Piazza S Onofrio, 4, 00165, Rome, Italy.
| | - A Deodati
- Diabetes Unit, Bambino Gesù Children's Hospital, Piazza S Onofrio, 4, 00165, Rome, Italy
| | - M C Nicoletti
- Pediatric Department, Siena University, Siena, Italy
| | - C Carducci
- Diabetes Unit, Bambino Gesù Children's Hospital, Piazza S Onofrio, 4, 00165, Rome, Italy
| | - P Ciampalini
- Diabetes Unit, Bambino Gesù Children's Hospital, Piazza S Onofrio, 4, 00165, Rome, Italy
| | - A Lorubbio
- Diabetes Unit, Bambino Gesù Children's Hospital, Piazza S Onofrio, 4, 00165, Rome, Italy
| | - M C Matteoli
- Diabetes Unit, Bambino Gesù Children's Hospital, Piazza S Onofrio, 4, 00165, Rome, Italy
| | - V Pampanini
- Diabetes Unit, Bambino Gesù Children's Hospital, Piazza S Onofrio, 4, 00165, Rome, Italy
| | - I P Patera
- Diabetes Unit, Bambino Gesù Children's Hospital, Piazza S Onofrio, 4, 00165, Rome, Italy
| | - N Rapini
- Diabetes Unit, Bambino Gesù Children's Hospital, Piazza S Onofrio, 4, 00165, Rome, Italy
| | - S Cianfarani
- Diabetes Unit, Bambino Gesù Children's Hospital, Piazza S Onofrio, 4, 00165, Rome, Italy
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health and Cell Biology, Rina Balducci Center of Pediatric Endocrinology, Tor Vergata University, Rome, Italy
| |
Collapse
|
43
|
Petrovski G, Al Khalaf F, Campbell J, Day E, Almajaly D, Hussain K, Pasha M, Umer F, Hamdan M, Khalifa A. Successful transitioning children and adolescents with type 1 diabetes from multiple daily injections to advanced hybrid closed-loop system in 10 days: a prospective intervention study on MiniMed 780G system. Acta Diabetol 2022; 59:743-746. [PMID: 35072781 DOI: 10.1007/s00592-022-01851-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/12/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Goran Petrovski
- Division of Endocrinology and Diabetes, Department of Pediatric Medicine, Sidra Medicine, HB 6E 219, Al Luqta Street, Education City North Campus, 26999, Doha, Qatar.
| | - Fawziya Al Khalaf
- Division of Endocrinology and Diabetes, Department of Pediatric Medicine, Sidra Medicine, HB 6E 219, Al Luqta Street, Education City North Campus, 26999, Doha, Qatar
| | - Judith Campbell
- Division of Endocrinology and Diabetes, Department of Pediatric Medicine, Sidra Medicine, HB 6E 219, Al Luqta Street, Education City North Campus, 26999, Doha, Qatar
| | - Emma Day
- Division of Endocrinology and Diabetes, Department of Pediatric Medicine, Sidra Medicine, HB 6E 219, Al Luqta Street, Education City North Campus, 26999, Doha, Qatar
| | - Douha Almajaly
- Division of Endocrinology and Diabetes, Department of Pediatric Medicine, Sidra Medicine, HB 6E 219, Al Luqta Street, Education City North Campus, 26999, Doha, Qatar
| | - Khalid Hussain
- Division of Endocrinology and Diabetes, Department of Pediatric Medicine, Sidra Medicine, HB 6E 219, Al Luqta Street, Education City North Campus, 26999, Doha, Qatar
| | - Maheen Pasha
- Division of Endocrinology and Diabetes, Department of Pediatric Medicine, Sidra Medicine, HB 6E 219, Al Luqta Street, Education City North Campus, 26999, Doha, Qatar
| | - Fareeda Umer
- Division of Endocrinology and Diabetes, Department of Pediatric Medicine, Sidra Medicine, HB 6E 219, Al Luqta Street, Education City North Campus, 26999, Doha, Qatar
| | - Manar Hamdan
- Division of Endocrinology and Diabetes, Department of Pediatric Medicine, Sidra Medicine, HB 6E 219, Al Luqta Street, Education City North Campus, 26999, Doha, Qatar
| | - Amel Khalifa
- Division of Endocrinology and Diabetes, Department of Pediatric Medicine, Sidra Medicine, HB 6E 219, Al Luqta Street, Education City North Campus, 26999, Doha, Qatar
| |
Collapse
|
44
|
Petrovski G, Al Khalaf F, Campbell J, Day E, Almajaly D, Hussain K, Pasha M, Umer F, Hamdan M, Khalifa A. Glycemic outcomes of Advanced Hybrid Closed Loop system in children and adolescents with Type 1 Diabetes, previously treated with Multiple Daily Injections (MiniMed 780G system in T1D individuals, previously treated with MDI). BMC Endocr Disord 2022; 22:80. [PMID: 35351095 PMCID: PMC8962027 DOI: 10.1186/s12902-022-00996-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 03/14/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The objective of this study was to evaluate the glycemic outcomes in children and adolescents with Type 1 Diabetes (T1D) previously treated with Multiple Daily Injections (MDI) using a structured initiation protocol for the Advanced Hybrid Closed Loop (AHCL) Minimed 780G insulin pump system. METHODS In this prospective open label single-arm, single-center, clinical investigation, we recruited children and adolescents (aged 7-17 years) with T1D on MDI therapy and HbA1c below 12.5%. All participants followed a 10-day structured initiation protocol which included 4 steps: step 1: AHCL system assessment; step 2: AHCL system training; step 3: Sensor augmented pump therapy (SAP) for 3 days; step 4: AHCL system use for 12 weeks, successfully completing the training from MDI to AHCL in 10 days. The primary outcome of the study was the change in the time spent in the target in range (TIR) of 70-180 mg/dl and HbA1c from baseline (MDI + CGM, 1 week) to study phase (AHCL, 12 weeks). The paired student t-test was used for statistical analysis and a value < 0.05 was considered statistically significant. RESULTS Thirty-four participants were recruited and all completed the 12 weeks study. TIR increased from 42.1 ± 18.7% at baseline to 78.8 ± 6.1% in the study phase (p < 0.001). HbA1c decreased from 8.6 ± 1.7% (70 ± 18.6 mmol/mol) at baseline, to 6.5 ± 0.7% (48 ± 7.7 mmol/mol) at the end of the study (p = 0.001). No episodes of severe hypoglycemia or DKA were reported. CONCLUSION Children and adolescents with T1D on MDI therapy who initiated the AHCL system following a 10-days structured protocol achieved the internationally recommended goals of glycemic control with TIR > 70% and a HbA1c of < 7%.
Collapse
Affiliation(s)
- Goran Petrovski
- Department of Pediatric Medicine, Division of Endocrinology and Diabetes, Sidra Medicine, PO Box 26999, HB 6E 219, Al Luqta Street, Education City North Campus, Doha, Qatar.
| | - Fawziya Al Khalaf
- Department of Pediatric Medicine, Division of Endocrinology and Diabetes, Sidra Medicine, PO Box 26999, HB 6E 219, Al Luqta Street, Education City North Campus, Doha, Qatar
| | - Judith Campbell
- Department of Pediatric Medicine, Division of Endocrinology and Diabetes, Sidra Medicine, PO Box 26999, HB 6E 219, Al Luqta Street, Education City North Campus, Doha, Qatar
| | - Emma Day
- Department of Pediatric Medicine, Division of Endocrinology and Diabetes, Sidra Medicine, PO Box 26999, HB 6E 219, Al Luqta Street, Education City North Campus, Doha, Qatar
| | - Douha Almajaly
- Department of Pediatric Medicine, Division of Endocrinology and Diabetes, Sidra Medicine, PO Box 26999, HB 6E 219, Al Luqta Street, Education City North Campus, Doha, Qatar
| | - Khalid Hussain
- Department of Pediatric Medicine, Division of Endocrinology and Diabetes, Sidra Medicine, PO Box 26999, HB 6E 219, Al Luqta Street, Education City North Campus, Doha, Qatar
| | - Maheen Pasha
- Department of Pediatric Medicine, Division of Endocrinology and Diabetes, Sidra Medicine, PO Box 26999, HB 6E 219, Al Luqta Street, Education City North Campus, Doha, Qatar
| | - Fareeda Umer
- Department of Pediatric Medicine, Division of Endocrinology and Diabetes, Sidra Medicine, PO Box 26999, HB 6E 219, Al Luqta Street, Education City North Campus, Doha, Qatar
| | - Manar Hamdan
- Department of Pediatric Medicine, Division of Endocrinology and Diabetes, Sidra Medicine, PO Box 26999, HB 6E 219, Al Luqta Street, Education City North Campus, Doha, Qatar
| | - Amel Khalifa
- Department of Pediatric Medicine, Division of Endocrinology and Diabetes, Sidra Medicine, PO Box 26999, HB 6E 219, Al Luqta Street, Education City North Campus, Doha, Qatar
| |
Collapse
|
45
|
Nimri R, Phillip M, Kovatchev B. Decision Support Systems and Closed-Loop. Diabetes Technol Ther 2022; 24:S58-S75. [PMID: 35475696 DOI: 10.1089/dia.2022.2504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Revital Nimri
- Diabetes Technology Center, Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Phillip
- Diabetes Technology Center, Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Boris Kovatchev
- University of Virginia Center for Diabetes Technology, University of Virginia School of Medicine, Charlottesville, VA
| |
Collapse
|
46
|
Carlson AL, Sherr JL, Shulman DI, Garg SK, Pop-Busui R, Bode BW, Lilenquist DR, Brazg RL, Kaiserman KB, Kipnes MS, Thrasher JR, Reed JHC, Slover RH, Philis-Tsimikas A, Christiansen M, Grosman B, Roy A, Vella M, Jonkers RA, Chen X, Shin J, Cordero TL, Lee SW, Rhinehart AS, Vigersky RA. 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; 24:178-189. [PMID: 34694909 PMCID: PMC8971997 DOI: 10.1089/dia.2021.0319] [Citation(s) in RCA: 102] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Introduction: This trial assessed safety and effectiveness of an advanced hybrid closed-loop (AHCL) system with automated basal (Auto Basal) and automated bolus correction (Auto Correction) in adolescents and adults with type 1 diabetes (T1D). Materials and Methods: This multicenter single-arm study involved an intent-to-treat population of 157 individuals (39 adolescents aged 14-21 years and 118 adults aged ≥22-75 years) with T1D. Study participants used the MiniMed™ AHCL system during a baseline run-in period in which sensor-augmented pump +/- predictive low glucose management or Auto Basal was enabled for ∼14 days. Thereafter, Auto Basal and Auto Correction were enabled for a study phase (∼90 days), with glucose target set to 100 or 120 mg/dL for ∼45 days, followed by the other target for ∼45 days. Study endpoints included safety events and change in mean A1C, time in range (TIR, 70-180 mg/dL) and time below range (TBR, <70 mg/dL). Run-in and study phase values were compared using Wilcoxon signed-rank test or paired t-test. Results: Overall group time spent in closed loop averaged 94.9% ± 5.4% and involved only 1.2 ± 0.8 exits per week. Compared with run-in, AHCL reduced A1C from 7.5% ± 0.8% to 7.0% ± 0.5% (<0.001, Wilcoxon signed-rank test, n = 155), TIR increased from 68.8% ± 10.5% to 74.5% ± 6.9% (<0.001, Wilcoxon signed-rank test), and TBR reduced from 3.3% ± 2.9% to 2.3% ± 1.7% (<0.001, Wilcoxon signed-rank test). Similar benefits to glycemia were observed for each age group and were more pronounced for the nighttime (12 AM-6 AM). The 100 mg/dL target increased TIR to 75.4% (n = 155), which was further optimized at a lower active insulin time (AIT) setting (i.e., 2 h), without increasing TBR. There were no severe hypoglycemic or diabetic ketoacidosis events during the study phase. Conclusions: These findings show that the MiniMed AHCL system is safe and allows for achievement of recommended glycemic targets in adolescents and adults with T1D. Adjustments in target and AIT settings may further optimize glycemia and improve user experience. Clinical Trial Registration number: NCT03959423.
Collapse
Affiliation(s)
- Anders L. Carlson
- International Diabetes Center, HealthPartners Institute, Minneapolis, Minnesota, USA
| | - Jennifer L. Sherr
- Yale University School of Medicine Pediatric Endocrinology, New Haven, Connecticut, USA
| | - Dorothy I. Shulman
- University of South Florida Diabetes and Endocrinology, Tampa, Florida, USA
| | - Satish K. Garg
- Barbara Davis Center of Childhood Diabetes, Aurora, Colorado, USA
| | - Rodica Pop-Busui
- Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan, USA
| | | | | | - Ron L. Brazg
- Rainier Clinical Research Center, Renton, Washington, USA
| | | | - Mark S. Kipnes
- Diabetes and Glandular Disease Clinic, San Antonio, Texas, USA
| | - James R. Thrasher
- Arkansas Diabetes and Endocrinology Center, Little Rock, Arkansas, USA
| | | | - Robert H. Slover
- Barbara Davis Center of Childhood Diabetes, Aurora, Colorado, USA
| | | | | | | | | | | | | | | | - John Shin
- Medtronic, Northridge, California, USA
| | | | | | | | | |
Collapse
|
47
|
Silva JD, Lepore G, Battelino T, Arrieta A, Castañeda J, Grossman B, Shin J, Cohen O. Real-World Performance of the MiniMed™ 780G System: First Report of Outcomes from 4120 Users. Diabetes Technol Ther 2022; 24:113-119. [PMID: 34524003 PMCID: PMC8817690 DOI: 10.1089/dia.2021.0203] [Citation(s) in RCA: 98] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background: The MiniMed™ 780G system includes an advanced hybrid closed loop (AHCL) algorithm that provides both automated basal and correction bolus insulin delivery. The preliminary performance of the system in real-world settings was evaluated. Methods: Data uploaded from August 2020 to March 2021 by individuals living in Belgium, Finland, Italy, the Netherlands, Qatar, South Africa, Sweden, Switzerland, and the United Kingdom were aggregated and retrospectively analyzed to determine the mean glucose management indicator (GMI), percentage of time spent within (TIR), below (TBR), and above (TAR) glycemic ranges, system use, and insulin consumption in users having ≥10 days of sensor glucose (SG) data after initiating AHCL. The impact of initiating AHCL was evaluated in a subgroup of users also having ≥10 days of SG data, before AHCL initiation. Results: Users (N = 4120) were observed for a mean of 54 ± 32 days. During this time, they spent a mean of 94.1% ± 11.4% of the time in AHCL and achieved a mean GMI of 6.8% ± 0.3%, TIR of 76.2% ± 9.1%, TBR <70 of 2.5% ± 2.1%, and TAR >180 of 21.3% ± 9.4%, after initiating AHCL. There were 77.3% and 79.0% of users who achieved a TIR >70% and a GMI of <7.0%, respectively. Users for whom comparison with pre-AHCL was possible (N = 812) reduced their GMI by 0.4% ± 0.4% (P = 0.005) and increased their TIR by 12.1% ± 10.5% (P < 0.0001), post-AHCL initiation. More users achieved the glycemic treatment goals of GMI <7.0% (37.6% vs. 75.2%, P < 0.0001) and TIR >70% (34.6% vs. 74.9%, P < 0.0001) when compared with pre-AHCL initiation. Conclusion: Most MiniMed 780G system users achieved TIR >70% and GMI <7%, while minimizing hypoglycemia, in a real-world condition.
Collapse
Affiliation(s)
- Julien Da Silva
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - Giuseppe Lepore
- Unit of Endocrine Diseases and Diabetology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Tadej Battelino
- University Children's Hospital, University Medical Centre Ljubljana, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Arcelia Arrieta
- Medtronic Bakken Research Center, Maastricht, The Netherlands
| | | | | | - John Shin
- Medtronic, Northridge, California, USA
| | - Ohad Cohen
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
- Address correspondence to: Ohad Cohen, MD, Medtronic International Trading Sàrl, Route du Molliau 31, Tolochenaz 1131, Switzerland
| |
Collapse
|
48
|
Seget S, Jarosz-Chobot P, Ochab A, Polanska J, Rusak E, Witoszek P, Chobot A. Body mass index, basal insulin and glycemic control in children with type 1 diabetes treated with the advanced hybrid closed loop system remain stable - 1-year prospective, observational, two-center study. Front Endocrinol (Lausanne) 2022; 13:1036808. [PMID: 36303875 PMCID: PMC9592809 DOI: 10.3389/fendo.2022.1036808] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/21/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Information on the influence of insulin treatment using advanced hybrid closed loop systems (AHCL) on body weight of young patients with type 1 diabetes (T1D) is scarce. The aim of this study was to observe whether there were any changes in body mass index (BMI) of children and adolescents with T1D treated using the Medtronic Minimed 780G AHCL after 1 year of follow up and to analyze potential associations between these changes and the insulin doses. MATERIALS AND METHODS For 50 children and adolescents (age 5.4-16.8 years, 24 (48%) boys, T1D for 3.9 ± 2.56 years) using an AHCL system anthropometric and AHCL data were collected prospectively. BMI Z-scores and two-week AHCL records obtained after AHCL enrollment were compared with data after 6 months and also 1 year after starting AHCL. RESULTS The BMI Z-score of the patients at 1 year follow-up did not change from time of AHCL initiation (0.51 ± 2.79 vs 0.57 ± 2.85, p>0.05). There was a slight increase in total daily insulin per kg of body weight (0.67 ± 0.21 U/kg vs 0.80 ± 0.21 U/kg, p <0.001), but the percent of basal insulin was unchanged (34.88 ± 6.91% vs 35.08 ± 6.30%, p>0.05). We observed also no change (AHCL start vs after 1 year) in glycemic control parameters: average sensor glucose (131.36± 11.04 mg/dL vs 132.45 ± 13.42 mg/dL, p>0.05), coefficient of variation (34.99± 5.17% vs 34.06 ± 5.38%, p>0.05), glucose management indicator (6.45 ± 0.26% vs 6.48 ± 0.32%, p>0.05), and time spent in the range of 70-180 mg/dL (79.28 ± 8.12% vs 80.40 ± 8.25%, p>0.05). CONCLUSION During the 1 year of follow-up the BMI of children and adolescents with T1D treated with an AHCL system remained stable. Although there was a slight increase in the total daily insulin dose, the percent of basal insulin was unchanged. The patients maintained recommended glycemic control.
Collapse
Affiliation(s)
- Sebastian Seget
- Department of Children’s Diabetology, Medical University of Silesia, Katowice, Poland
| | | | - Agnieszka Ochab
- Department of Pediatrics, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Joanna Polanska
- Department of Data Science and Engineering, Silesian University of Technology, Gliwice, Poland
| | - Ewa Rusak
- Department of Children’s Diabetology, Medical University of Silesia, Katowice, Poland
| | - Paulina Witoszek
- Department of Children’s Diabetology and Pediatrics, John Paul II Upper Silesian Child Health Centre, Katowice, Poland
| | - Agata Chobot
- Department of Pediatrics, Institute of Medical Sciences, University of Opole, Opole, Poland
- *Correspondence: Agata Chobot,
| |
Collapse
|
49
|
Nallicheri A, Mahoney KM, Gutow HA, Bellini N, Isaacs D. Review of Automated Insulin Delivery Systems for Type 1 Diabetes and Associated Time in Range Outcomes. Endocrinology 2022; 18:27-34. [PMID: 35949359 PMCID: PMC9354504 DOI: 10.17925/ee.2022.18.1.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/07/2022] [Indexed: 11/24/2022]
Abstract
Automated insulin delivery (AID) systems play an important role in the management of type 1 diabetes mellitus (T1DM). These systems include three components: a continuous glucose monitor (CGM), an insulin pump and an algorithm that adjusts the pump based on the CGM sensor glucose readings. They are not fully automated and still require the user to administer bolus insulin doses for food. Some AID systems have automatic correction boluses, while others only have automatic basal or background insulin adjustments. As CGM has become more accurate and the technology has evolved, AID systems have demonstrated improved glycaemic outcomes. The clinical evaluation of AID systems in randomized controlled trials and real-world studies have shown their utility in helping glycaemic management. In this review, we compare AID systems that are commercially available in the US and summarize the literature, with a special focus on time in range in T1DM. The review also discusses new AID systems on the horizon and explores considerations for personalized care.
Collapse
|
50
|
von dem Berge T, Biester S, Biester T, Buchmann AK, Datz N, Grosser U, Kapitzke K, Klusmeier B, Remus K, Reschke F, Tiedemann I, Weiskorn J, Würsig M, Thomas A, Kordonouri O, Danne T. Empfehlungen zur Diabetes-Behandlung mit automatischen Insulin-Dosierungssystemen. DIABETOL STOFFWECHS 2021. [DOI: 10.1055/a-1652-9011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
ZusammenfassungDas Prinzip der automatischen Insulindosierung, kurz „AID“ genannt, zeigt in Zulassungsstudien und Real-World-Erfahrungen ausgezeichnete Behandlungsergebnisse. Beim AID wird eine Insulinpumpe mit einem System zur kontinuierlichen Glukosemessung zusammengeschaltet, während ein Rechenprogramm, der sogenannte Algorithmus, die Steuerung der Insulingabe nach Bedarf übernimmt. Idealerweise wäre das System ein geschlossener Kreis, bei dem die Menschen mit Diabetes keine Eingabe mehr machen müssten. Jedoch sind bei den heute verfügbaren Systemen verschiedene Grundeinstellungen und Eingaben erforderlich (insbesondere von Kohlenhydratmengen der Mahlzeiten oder körperlicher Aktivität), die sich von den bisherigen Empfehlungen der sensorunterstützten Pumpentherapie in einzelnen Aspekten unterscheiden. So werden die traditionellen Konzepte von „Basal“ und „Bolus“ mit AID weniger nützlich, da der Algorithmus beide Arten der Insulinabgabe verwendet, um die Glukosewerte dem eingestellten Zielwert zu nähern. Daher sollte bei diesen Systemen statt der Erfassung von „Basal“ und „Bolus“, zwischen einer „nutzerinitiierten“ und einer „automatischen“ Insulindosis unterschieden werden. Gemeinsame Therapieprinzipien der verschiedenen AID-Systeme umfassen die passgenaue Einstellung des Kohlenhydratverhältnisses, die Bedeutung des Timings der vom Anwender initiierten Insulinbolusgaben vor der Mahlzeit, den korrekten Umgang mit einem verzögerten oder versäumten Mahlzeitenbolus, neue Prinzipien im Umgang mit Sport oder Alkoholgenuss sowie den rechtzeitigen Umstieg von AID zu manuellem Modus bei Auftreten erhöhter Ketonwerte. Das Team vom Diabetes-Zentrum AUF DER BULT in Hannover hat aus eigenen Studienerfahrungen und der zugrunde liegenden internationalen Literatur praktische Empfehlungen zur Anwendung und Schulung der gegenwärtig und demnächst in Deutschland kommerziell erhältlichen Systeme zusammengestellt. Für den Erfolg der AID-Behandlung scheint das richtige Erwartungsmanagement sowohl beim Behandlungsteam und als auch beim Anwender von großer Bedeutung zu sein.
Collapse
Affiliation(s)
- Thekla von dem Berge
- Diabetes-Zentrum für Kinder und Jugendliche, AUF DER BULT, Kinder- und Jugendkrankenhaus, Hannover, Germany
| | - Sarah Biester
- Diabetes-Zentrum für Kinder und Jugendliche, AUF DER BULT, Kinder- und Jugendkrankenhaus, Hannover, Germany
| | - Torben Biester
- Diabetes-Zentrum für Kinder und Jugendliche, AUF DER BULT, Kinder- und Jugendkrankenhaus, Hannover, Germany
| | - Anne-Kathrin Buchmann
- Diabetes-Zentrum für Kinder und Jugendliche, AUF DER BULT, Kinder- und Jugendkrankenhaus, Hannover, Germany
| | - Nicolin Datz
- Diabetes-Zentrum für Kinder und Jugendliche, AUF DER BULT, Kinder- und Jugendkrankenhaus, Hannover, Germany
| | - Ute Grosser
- Diabetes-Zentrum für Kinder und Jugendliche, AUF DER BULT, Kinder- und Jugendkrankenhaus, Hannover, Germany
| | - Kerstin Kapitzke
- Diabetes-Zentrum für Kinder und Jugendliche, AUF DER BULT, Kinder- und Jugendkrankenhaus, Hannover, Germany
| | - Britta Klusmeier
- Diabetes-Zentrum für Kinder und Jugendliche, AUF DER BULT, Kinder- und Jugendkrankenhaus, Hannover, Germany
| | - Kerstin Remus
- Diabetes-Zentrum für Kinder und Jugendliche, AUF DER BULT, Kinder- und Jugendkrankenhaus, Hannover, Germany
| | - Felix Reschke
- Diabetes-Zentrum für Kinder und Jugendliche, AUF DER BULT, Kinder- und Jugendkrankenhaus, Hannover, Germany
| | - Inken Tiedemann
- Diabetes-Zentrum für Kinder und Jugendliche, AUF DER BULT, Kinder- und Jugendkrankenhaus, Hannover, Germany
| | - Jantje Weiskorn
- Diabetes-Zentrum für Kinder und Jugendliche, AUF DER BULT, Kinder- und Jugendkrankenhaus, Hannover, Germany
| | - Martina Würsig
- Diabetes-Zentrum für Kinder und Jugendliche, AUF DER BULT, Kinder- und Jugendkrankenhaus, Hannover, Germany
| | | | - Olga Kordonouri
- Diabetes-Zentrum für Kinder und Jugendliche, AUF DER BULT, Kinder- und Jugendkrankenhaus, Hannover, Germany
| | - Thomas Danne
- Diabetes-Zentrum für Kinder und Jugendliche, AUF DER BULT, Kinder- und Jugendkrankenhaus, Hannover, Germany
| |
Collapse
|