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Martin-Payo R, Fernandez-Alvarez MDM, García-García R, Pérez-Varela Á, Surendran S, Riaño-Galán I. Effectiveness of a hybrid closed-loop system for children and adolescents with type 1 diabetes during physical exercise: A cross-sectional study in real life. An Pediatr (Barc) 2024; 101:183-189. [PMID: 39112134 DOI: 10.1016/j.anpede.2024.07.015] [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] [Received: 03/05/2024] [Accepted: 05/22/2024] [Indexed: 09/17/2024] Open
Abstract
OBJECTIVE The aim of the study was to describe how physical exercise affects metabolic control, insulin requirements and carbohydrate intake in children who use hybrid closed-loop systems. METHODS Cross-sectional study design. The sample included 21 children and adolescents diagnosed with type 1 diabetes. During the study, participants were monitored for a period of 7 days to gather comprehensive data on these factors. RESULTS Nine participants (42.9%) had switched to exercise mode to raise the target glucose temporarily to 150 mg/dL. The HbA1c values ranged from 5.5% to 7.9% (median, 6.5%; IQR, 0.75). The percentage of time within the target range of 70-180 mg/dL was similar; however, there was an increased duration of hyperglycaemia and more autocorrections on exercise days. The time spent in severe hyperglycaemia (>250 mg/dL) increased by 2.7% in exercise compared to non-exercise days (P = .02). It is worth noting that hypoglycaemic episodes did not increase during the exercise days compared with non-exercise days. CONCLUSION The hybrid closed-loop system was effective and safe in children and adolescents with type 1 diabetes during the performance of competitive sports in real life.
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Affiliation(s)
- Ruben Martin-Payo
- Facultad de Medicina y Ciencias de la Salud, Universidad de Oviedo, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Maria Del Mar Fernandez-Alvarez
- Facultad de Medicina y Ciencias de la Salud, Universidad de Oviedo, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.
| | - Rebeca García-García
- Facultad de Medicina y Ciencias de la Salud, Universidad de Oviedo, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain; Endocrinología Pediátrica, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Ángela Pérez-Varela
- Facultad de Medicina y Ciencias de la Salud, Universidad de Oviedo, Oviedo, Spain
| | - Shelini Surendran
- Departamento de Biociencias, Facultad de Ciencias Médicas y de La Salud, University of Surrey, United Kingdom
| | - Isolina Riaño-Galán
- Facultad de Medicina y Ciencias de la Salud, Universidad de Oviedo, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain; Endocrinología Pediátrica, Hospital Universitario Central de Asturias, Oviedo, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Karakus KE, Klein MP, Akturk HK, Shah VN. Changes in Basal and Bolus Insulin Requirements with Tirzepatide as an Adjunctive Therapy in Adults with Type 1 Diabetes Using Tandem Control-IQ. Diabetes Ther 2024; 15:1647-1655. [PMID: 38743306 PMCID: PMC11211304 DOI: 10.1007/s13300-024-01592-9] [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: 04/02/2024] [Accepted: 04/15/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION This study was aimed at investigating changes in insulin requirements and glycemic outcomes in adults with type 1 diabetes (T1D) using Control IQ (Tandem Diabetes) automated insulin delivery system (AID) over 8 months of tirzepatide treatment. METHODS In this single-center, observational study, we collected demographic, A1c, weight, sensor glucose, and insulin dose data for adults with T1D who were using AID and initiated tirzepatide adjunct therapy for clinical indications (n = 11, median age 37, 64% female and mean body mass index of 39.6 kg/m2). Data were compared from baseline and over 8 months. RESULTS Within 2 months of tirzepatide treatment, there were significant reductions in total daily insulin [median (IQR) 73.9 (47.6-95.8) to 51.7 (46.7-66.8) units/day, p < 0.001], basal insulin [47 (28.2-51.8) to 32.4 (25.5-46.3) units/day, p < 0.001], and bolus insulin [31.4 (19.9-38.3) to 17.9 (14.9-22.2) units/day, p < 0.001] requirements. Insulin dose reduction from 2 to 8 months was modest. The frequency of user-initiated boluses did not differ throughout the study. Despite reductions in total insulin requirement, time in range (70-180 mg/dl) increased by 7%, A1c reduced by 0.5%, weight reduced by 9%, without increase in time below 70 mg/dl. CONCLUSIONS This pilot study provides clinical guidance on insulin titration for adults with T1D who may initiate tirzepatide therapy. Based on the findings of this study, we recommend reducing 25% of total daily insulin dose at tirzepatide initiation in adults with T1D using AID with baseline A1c of less than 7.5%. Higher doses of tirzepatide were associated with greater weight loss, however, the reduction in insulin requirement was minimal.
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Affiliation(s)
- Kagan E Karakus
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Matthew P Klein
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Halis K Akturk
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Viral N Shah
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA.
- Division of Endocrinology and Metabolism, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
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Enciso Izquierdo FJ, Amaya García MJ, Cordero Vaquero AA, Lucas Gamero JA, Gomez-Barrado Turégano P, Luengo Andrada M, Cordero Pearson A, Grau Figueredo RJ. Retrospective observational study on real world use of the Minimed™ 780G automated insulin delivery system: Impact of the settings on autocorrection and omitted meal boluses. ENDOCRINOL DIAB NUTR 2024; 71:229-235. [PMID: 38942701 DOI: 10.1016/j.endien.2024.03.019] [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: 01/02/2024] [Revised: 03/03/2024] [Accepted: 03/04/2024] [Indexed: 06/30/2024]
Abstract
INTRODUCTION The Medtronic MiniMed™ 780G (MM780G) system uses an algorithm that includes autocorrection bolus (AB) delivery. This study evaluates the impact of omitted meal boluses and the system settings, glucose target and active insulin time (AIT), on the AB. METHOD Retrospective observational study on data uploaded by all MiniMed 780G users in our healthcare area, obtained through the remote monitoring platform Care Connect, from April to August 2023. Downloads with a sensor usage time <95% were excluded. RESULTS 235 downloads belonging to 235 users were analysed. AB delivery was significantly higher at 2 h AIT (36.08 ± 13.17%) compared to the rest of settings (2.25-4 h) (26.43 ± 13.2%) (p < 0.001). AB differences based on the glucose target were not found. Patients with <3 meal boluses per day had higher AB delivery (46.91 ± 19.00% vs 27.53 ± 11.54%) (p < 0.001) and had more unfavourable glucometric parameters (GMI 7.12 ± 0.45%, TIR 67.46 ± 12.89% vs GMI 6.78 ± 0.3%, TIR 76.51 ± 8.37%) (p < 0.001). However, the 2-h AIT group presented similar TAR, TIR and GMI regardless of the number of meal boluses. CONCLUSION The fewer user-initiated boluses, the greater the autocorrection received. The active insulin time of 2 h entails a more active autocorrection pattern that makes it possible to more effectively compensate for the omission of meal boluses without increasing hypoglycaemias.
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Affiliation(s)
| | - María José Amaya García
- Unidad de Endocrinología y Nutrición, Hospital Universitario San Pedro de Alcantara, Cáceres, Spain.
| | | | | | | | - María Luengo Andrada
- Unidad de Endocrinología y Nutrición, Hospital Universitario San Pedro de Alcantara, Cáceres, Spain
| | - Andrea Cordero Pearson
- Unidad de Endocrinología y Nutrición, Hospital Universitario San Pedro de Alcantara, Cáceres, Spain
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Passanisi S, Lombardo F, Mameli C, Bombaci B, Macedoni M, Zuccotti G, Dovc K, Battelino T, Salzano G, Delvecchio M. Safety, Metabolic and Psychological Outcomes of Medtronic MiniMed 780G™ in Children, Adolescents and Young Adults: A Systematic Review. Diabetes Ther 2024; 15:343-365. [PMID: 38038896 PMCID: PMC10838896 DOI: 10.1007/s13300-023-01501-6] [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: 08/11/2023] [Accepted: 10/20/2023] [Indexed: 12/02/2023] Open
Abstract
The MiniMed™ 780G is a second-generation automated insulin delivery system that implements a modified proportional-integral-derivative algorithm with some features of an MD-Logic artificial pancreas algorithm. The system may deliver automatic correction boluses up to every 5 min, and it allows the user to choose between three glucose target setpoints (100, 110 and 120 mg/dL). We aimed to review the current evidence on this device in children, adolescents, and young adults living with type 1 diabetes. We screened 783 papers, but only 31 manuscripts were included in this review. Data on metabolic outcomes show that this system is safe as regards severe hypoglycaemia and diabetic ketoacidosis. The glycated haemoglobin may drop to levels about 7%, with CGM reports showing a time in range of 75-80%. The time above range and the time below range are within the recommended target in most of the subjects. Few studies evaluated the psychological outcomes. This system seems to be more effective than the first-generation automated insulin delivery systems. The MiniMed™ 780G has been associated with an improvement in sleep quality in subjects living with diabetes and their caregivers, along with an improvement in treatment satisfaction. Psychological distress is as reduced as the glucose control is improved. We also discuss some case reports describing particular situations in clinical practice. Finally, we think that data show that this system is a further step towards the improvement of the treatment of diabetes as concerns both metabolic and psychological outcomes.
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Affiliation(s)
- Stefano Passanisi
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
| | - Fortunato Lombardo
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
| | - Chiara Mameli
- Department of Pediatrics, Buzzi Children's Hospital, University of Milan, Milan, Italy
- Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Bruno Bombaci
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
| | - Maddalena Macedoni
- Department of Pediatrics, Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Gianvincenzo Zuccotti
- Department of Pediatrics, Buzzi Children's Hospital, University of Milan, Milan, Italy
- Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Klemen Dovc
- University Medical Center Ljubljana, University of Ljubljana, Ljubljana, Slovenia
| | - Tadej Battelino
- University Medical Center Ljubljana, University of Ljubljana, Ljubljana, Slovenia
| | - Giuseppina Salzano
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
| | - Maurizio Delvecchio
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
- Metabolic Disorders and Clinical Genetics, "Giovanni XXIII" Children's Hospital, AOU Policlinico-Giovanni XXIII, Via Giovanni Amendola 207, 70126, Bari, BA, Italy.
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Lendínez-Jurado A, López-Siguero JP, Gómez-Perea A, Ariza-Jiménez AB, Becerra-Paz I, Tapia-Ceballos L, Cruces-Ponce C, Jiménez-Hinojosa JM, Morcillo S, Leiva-Gea I. Pediatric Type 1 Diabetes: Is Age at Onset a Determining Factor in Advanced Hybrid Closed-Loop Insulin Therapy? J Clin Med 2023; 12:6951. [PMID: 37959415 PMCID: PMC10647771 DOI: 10.3390/jcm12216951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/26/2023] [Accepted: 11/03/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND The integration of continuous glucose monitoring systems with insulin infusion pumps has shown improved glycemic control, with improvements in hyperglycemia, hypoglycemia, Hb1Ac, and greater autonomy in daily life. These have been most studied in adults and there are currently not many articles published in the pediatric population that establish their correlation with age of debut. METHODS Prospective, single-study. A total of 28 patients (mean age 12 ± 2.43 years, 57% male, duration of diabetes 7.84 ± 2.46 years) were included and divided into two groups according to age at T1D onset (≤4 years and >4 years). Follow-up for 3 months, with glucometric variables extracted at different cut-off points after the start of the closed-loop (baseline, 1 month, 3 months). RESULTS Significant improvement was evidenced at 1 month and 3 months after closed-loop system implantation, with better glycemic control in the older age group at baseline at TIR (74.06% ± 6.37% vs. 80.33% ± 7.49% at 1 month, p < 0.003; 71.87% ± 6.58% vs. 78.75% ± 5.94% at 3 months, p < 0.009), TAR1 (18.25% ± 4.54% vs. 14.33% ± 5.74% at 1 month, p < 0.006; 19.87% ± 5.15% vs. 14.67% ± 4. 36% at 3 months, p < 0.009) and TAR2 (4.75% ± 2.67% vs. 2.75% ± 1.96% at 1 month, p = 0.0307; 5.40% ± 2.85% vs. 3% ± 2.45% at 3 months, p < 0.027). CONCLUSIONS the use of automated systems such as the MiniMedTM780G system brings glucometric results closer to those recommended by consensus, especially in age at T1D onset >4 years. However, the management in pediatrics continues to be a challenge even after the implementation of these systems, especially in terms of hyperglycemia and glycemic variability.
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Affiliation(s)
- Alfonso Lendínez-Jurado
- Department of Pediatric Endocrinology, Hospital Regional Universitario de Málaga, 29011 Málaga, Spain; (J.P.L.-S.); (A.G.-P.); (I.B.-P.); (L.T.-C.); (C.C.-P.); (J.M.J.-H.); (I.L.-G.)
- Departamento de Farmacología y Pediatría, Universidad de Málaga, Andalucía Tech, Campus de Teatinos s/n, 29071 Málaga, Spain
| | - Juan Pedro López-Siguero
- Department of Pediatric Endocrinology, Hospital Regional Universitario de Málaga, 29011 Málaga, Spain; (J.P.L.-S.); (A.G.-P.); (I.B.-P.); (L.T.-C.); (C.C.-P.); (J.M.J.-H.); (I.L.-G.)
- Departamento de Farmacología y Pediatría, Universidad de Málaga, Andalucía Tech, Campus de Teatinos s/n, 29071 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain;
| | - Ana Gómez-Perea
- Department of Pediatric Endocrinology, Hospital Regional Universitario de Málaga, 29011 Málaga, Spain; (J.P.L.-S.); (A.G.-P.); (I.B.-P.); (L.T.-C.); (C.C.-P.); (J.M.J.-H.); (I.L.-G.)
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain;
| | - Ana B. Ariza-Jiménez
- Department of Pediatric Endocrinology, Hospital Universitario Reina Sofía, 14004 Córdoba, Spain;
- Department of Pediatrics, University of Cordoba, Av. Menéndez Pidal, 7, 14004 Córdoba, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14004 Córdoba, Spain
| | - Icía Becerra-Paz
- Department of Pediatric Endocrinology, Hospital Regional Universitario de Málaga, 29011 Málaga, Spain; (J.P.L.-S.); (A.G.-P.); (I.B.-P.); (L.T.-C.); (C.C.-P.); (J.M.J.-H.); (I.L.-G.)
| | - Leopoldo Tapia-Ceballos
- Department of Pediatric Endocrinology, Hospital Regional Universitario de Málaga, 29011 Málaga, Spain; (J.P.L.-S.); (A.G.-P.); (I.B.-P.); (L.T.-C.); (C.C.-P.); (J.M.J.-H.); (I.L.-G.)
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain;
| | - Carmen Cruces-Ponce
- Department of Pediatric Endocrinology, Hospital Regional Universitario de Málaga, 29011 Málaga, Spain; (J.P.L.-S.); (A.G.-P.); (I.B.-P.); (L.T.-C.); (C.C.-P.); (J.M.J.-H.); (I.L.-G.)
| | - José Manuel Jiménez-Hinojosa
- Department of Pediatric Endocrinology, Hospital Regional Universitario de Málaga, 29011 Málaga, Spain; (J.P.L.-S.); (A.G.-P.); (I.B.-P.); (L.T.-C.); (C.C.-P.); (J.M.J.-H.); (I.L.-G.)
| | - Sonsoles Morcillo
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain;
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain
- CIBER in Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III Madrid, 29010 Málaga, Spain
| | - Isabel Leiva-Gea
- Department of Pediatric Endocrinology, Hospital Regional Universitario de Málaga, 29011 Málaga, Spain; (J.P.L.-S.); (A.G.-P.); (I.B.-P.); (L.T.-C.); (C.C.-P.); (J.M.J.-H.); (I.L.-G.)
- Departamento de Farmacología y Pediatría, Universidad de Málaga, Andalucía Tech, Campus de Teatinos s/n, 29071 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain;
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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.
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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
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The Use of a Hybrid Closed-Loop System for Glycemic Control in Two Pediatric Patients with Type 1 Diabetes Undergoing Minor Surgery. Healthcare (Basel) 2023; 11:healthcare11040587. [PMID: 36833120 PMCID: PMC9957216 DOI: 10.3390/healthcare11040587] [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: 10/03/2022] [Revised: 01/22/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
Technological progress in the treatment of type 1 diabetes requires doctors to use modern methods of insulin therapy in all areas of medicine that patients may come into contact with, including surgical interventions. The current guidelines indicate the possibility of using continuous subcutaneous insulin infusion in minor surgical procedures, but there are few reported cases of using a hybrid closed-loop system in perioperative insulin therapy. This case presentation focuses on two children with type 1 diabetes who were treated with an advanced hybrid closed-loop (AHCL) system during a minor surgical procedure. In the periprocedural period, the recommended mean glycemia and the time in range were maintained.
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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: 15] [Impact Index Per Article: 7.5] [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.
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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,
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