1
|
Akiyama T, Yamakawa T, Orime K, Ichikawa M, Harada M, Netsu T, Akamatsu R, Nakamura K, Shinoda S, Terauchi Y. Effects of hybrid closed-loop system on glycemic control and psychological aspects in persons with type 1 diabetes treated with sensor-augmented pump: A prospective single-center observational study. J Diabetes Investig 2024; 15:219-226. [PMID: 37934090 PMCID: PMC10804894 DOI: 10.1111/jdi.14103] [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: 06/30/2023] [Revised: 09/28/2023] [Accepted: 10/09/2023] [Indexed: 11/08/2023] Open
Abstract
AIMS/INTRODUCTION This study evaluated the effects of the Medtronic MiniMed 770G hybrid closed-loop system on glycemic control and psychological aspects in persons with type 1 diabetes mellitus. MATERIALS AND METHODS This 3-month prospective observational study included 22 participants with type 1 diabetes mellitus who used the Medtronic MiniMed 640G predictive low-glucose suspend system and were switched to the 770G system. Time in the range of 70-180 mg/dL and glycated hemoglobin levels were evaluated; satisfaction, emotional distress and quality of life were assessed using self-reported questionnaires, including the Diabetes Treatment Satisfaction Questionnaire Status, Problem Area in Diabetes and Diabetes Therapy-Related Quality of Life. RESULTS Time in the range of 70-180 mg/dL increased (63.5 ± 13.4 to 73.0 ± 10.9% [mean ± standard deviation], P = 0.0010), and time above the range of 181-250 mg/dL decreased (26.9 ± 8.9 to 19.6 ± 7.1%, P < 0.0005). Glycated hemoglobin levels decreased (7.7 ± 1.0 to 7.2 ± 0.8%, P = 0.0021). The percentage of participants with time below the range of 54-69 mg/dL <4% of readings increased from 91% to 100% (P < 0.0005). No significant changes were detected in the satisfaction, emotional distress and quality of life levels, but increased sensor calibration might be related to worsened emotional distress and quality of life. CONCLUSIONS The hybrid closed-loop system decreased hyperglycemia and minimized hypoglycemia, but did not improve psychological aspects compared with the predictive low-glucose suspend system, probably because sensor calibration was increased.
Collapse
Affiliation(s)
- Tomoaki Akiyama
- Department of Endocrinology and DiabetesYokohama City University Medical CenterYokohamaJapan
| | - Tadashi Yamakawa
- Department of Endocrinology and DiabetesYokohama City University Medical CenterYokohamaJapan
- Kanazawa Medical ClinicYokohamaJapan
| | - Kazuki Orime
- Department of Endocrinology and DiabetesYokohama City University Medical CenterYokohamaJapan
| | - Masahiro Ichikawa
- Department of Endocrinology and DiabetesYokohama City University Medical CenterYokohamaJapan
| | - Marina Harada
- Department of Endocrinology and DiabetesYokohama City University Medical CenterYokohamaJapan
| | - Takumi Netsu
- Department of Endocrinology and DiabetesYokohama City University Medical CenterYokohamaJapan
| | - Ryoichi Akamatsu
- Department of Endocrinology and DiabetesYokohama City University Medical CenterYokohamaJapan
| | - Keita Nakamura
- Department of Endocrinology and DiabetesYokohama City University Medical CenterYokohamaJapan
| | - Satoru Shinoda
- Department of BiostatisticsYokohama City University School of MedicineYokohamaJapan
| | - Yasuo Terauchi
- Department of Endocrinology and MetabolismYokohama City University School of MedicineYokohamaJapan
| |
Collapse
|
2
|
Notemi LM, Amoura L, Fall Mostaine F, Meyer L, Paris D, Talha S, Pottecher J, Kessler L. Long-term efficacy of sensor-augmented pump therapy (Minimed 640G system) combined with a telemedicine follow-up in patients with type 1 diabetes: A real life study. J Clin Transl Endocrinol 2022; 30:100306. [PMID: 36238800 PMCID: PMC9550647 DOI: 10.1016/j.jcte.2022.100306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/22/2022] [Accepted: 09/26/2022] [Indexed: 10/25/2022] Open
Abstract
Objective Evaluate the efficacy of a new modality of insulin therapy associating both the sensor-augmented pump therapy with predictive low-glucose management (SAP-PLGM) and a telemedicine follow-up in patients with Type 1 diabetes (T1D) in a real-life setting. Methods T1D adults under Minimed 640G system with a telemedicine follow-up for glucose management were included in a retrospective study. The primary endpoint was HbA1c while continuous glucose monitoring parameters (CGM) and treatment compliance were the secondary endpoints. These parameters were analyzed according to the therapeutic indication, HbA1c ≥ 8 % (Group A) or severe hypoglycemic events (Group B) and in patients switched to SAP-PLGM therapy. Results 62 patients were analyzed with a 28 ± 12 months of follow-up. In Group A, HbA1c decreased from 8.3 ± 0.4 % to 7.7 ± 0.7 % (p < 0.05) and to 7.9 ± 0.3 % (p < 0.05) after 2 and 3 years, respectively. In patients switched to SAP-PLGM therapy, HbA1c decreased from 7.7 ± 0.7 % to 7.2 ± 0.8 % (p < 0.05) at 2 years. After 6 months, the time-below-range (<70 mg/dL) decreased from 2.1 % [0.6-4] to 1.1 % [0.3-2.6] (p < 0.05). Severe hypoglycemic events decreased from 1.62 to 0.5 events/patient/year in Group B (p < 0.05). At 3 years, treatment compliance was 92 % [70-97] in the total population. Conclusions Long-term real-life treatment with the SAP-PLGM therapy combined with telemedicine was associated with improved glycemic control in T1D, along with high treatment compliance.
Collapse
Affiliation(s)
- Léonie Makuété Notemi
- Department of Endocrinology, Diabetes and Nutrition, University Hospital of Strasbourg, 1 place de l'Hôpital, 67091 Strasbourg Cedex, France
| | - Lamia Amoura
- Department of Endocrinology, Diabetes and Nutrition, University Hospital of Strasbourg, 1 place de l'Hôpital, 67091 Strasbourg Cedex, France
| | - Fatéma Fall Mostaine
- Department of Endocrinology, Diabetes and Nutrition, University Hospital of Strasbourg, 1 place de l'Hôpital, 67091 Strasbourg Cedex, France
| | - Laurent Meyer
- Department of Endocrinology, Diabetes and Nutrition, University Hospital of Strasbourg, 1 place de l'Hôpital, 67091 Strasbourg Cedex, France
| | - Dominique Paris
- Department of Endocrinology, Diabetes and Nutrition, University Hospital of Strasbourg, 1 place de l'Hôpital, 67091 Strasbourg Cedex, France
| | - Samy Talha
- Department of Physiology and Functional Explorations, Pole of Thoracic Pathology, University Hospital of Strasbourg, 1 place de l'Hôpital, 67091 Strasbourg cedex, France,UR 3072, « Mitochondria, Oxidative Stress and Muscle Protection », CRBS, CS 60026, 1, rue Eugène Boeckel, 67084 Strasbourg Cedex, France
| | - Julien Pottecher
- Anesthesia-intensive Care Department and Peri-Operative Medicine, Hautepierre Hospital, 1, Avenue Molière, 67098 Strasbourg Cedex, France
| | - Laurence Kessler
- Department of Endocrinology, Diabetes and Nutrition, University Hospital of Strasbourg, 1 place de l'Hôpital, 67091 Strasbourg Cedex, France,INSERM UMR 1260 - Regenerative Nanomedicine, Organ Dysfunction and Transplantation, University of Strasbourg, Pharmacy Faculty 74 route du Rhin, 67401 Illkirch, France,Corresponding author at: Department of Endocrinology, Diabetes and Nutrition, University Hospital of Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg Cedex, France.
| |
Collapse
|
3
|
Joubert M, Briant AR, Kessler L, Fall-Mostaine F, Dubois S, Guerci B, Schoumacker-Ley L, Reznik Y, Parienti JJ. Sensor-Augmented Insulin Pump with Predictive Low-Glucose Suspend (PLGS): Determining Optimal Settings of Pump and Sensor in a Multicenter Cohort of Patients with Type 1 Diabetes. Diabetes Ther 2022; 13:1645-1657. [PMID: 35913656 PMCID: PMC9399327 DOI: 10.1007/s13300-022-01302-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 07/14/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The use of predictive low-glucose suspend (PLGS) sensor-augmented pumps has been shown to lead to a significant reduction in hypoglycemic episodes in patients with type 1 diabetes (T1D), but their effects on hyperglycemia exposure are heterogeneous. The aim of this study was to determine the settings of the Medtronic 640G system to obtain the optimal balance between occurrence of both hypoglycemia and hyperglycemia. METHODS The hypo- and hyperglycemia area under the curve (AUC), as well as system settings [hypoglycemic threshold, mean insulin total daily dose (TDD), mean basal insulin percentage, and mean daily duration of PLGS] were collected between 2 and 12 times during 1 year in patients from four university hospital centers. Univariate/multivariate analyses and receiver operating characteristics (ROC) curves were performed to determine factors associated with hyper- and hypoglycemia AUC. RESULTS A total of 864 observations were analyzed from 110 patients with T1D. Two preselected settings predictive of low hyperglycemia AUC were a basal insulin percentage < 52.0% [sensitivity (Se) = 0.66 and specificity (Sp) = 0.53] and a PLGS duration > 157.5 min/day (Se = 0.47 and Sp = 0.73). The preselected setting predictive of a low hypoglycemia AUC was a PLGS duration ≤ 174.4 min (Se = 0.83 and Sp = 0.51). Between-visit variation of PLGS and TDD was positively correlated (r = 0.61; p < 0.0001). CONCLUSION The most important Medtronic 640G setting was the mean daily PLGS duration, where a value between 157.5 and 174.4 min/day was associated with the best reduction in both hypo- and hyperglycemia AUC. In this study, we showed that PLGS duration could be indirectly modified through total daily insulin dose adaptation. TRIAL REGISTRATION This study is registered in clinicaltrials.gov (NCT03047486).
Collapse
Affiliation(s)
- Michael Joubert
- Diabetes Care Unit, Caen University Hospital, 14033, Caen cedex 09, France.
- UNICAEN, University of Caen, Caen, France.
| | - Anaïs R Briant
- Biostatistics Unit, Caen University Hospital, Caen, France
| | - Laurence Kessler
- Diabetes Care Unit, Strasbourg University Hospital, Strasbourg, France
| | | | - Severine Dubois
- Diabetes Care Unit, Angers University Hospital, Angers, France
| | - Bruno Guerci
- Diabetes Care Unit, Nancy University Hospital, Nancy, France
| | | | - Yves Reznik
- Diabetes Care Unit, Caen University Hospital, 14033, Caen cedex 09, France
- UNICAEN, University of Caen, Caen, France
| | - Jean-Jacques Parienti
- UNICAEN, University of Caen, Caen, France
- Biostatistics Unit, Caen University Hospital, Caen, France
- INSERM UMR 1311, UNICAEN, Caen, France
| |
Collapse
|