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Landau Z, Lebenthal Y, Mazor-Aronovitch K, Brener A, Levek N, Jacobi-Polishook T, Ben Ari T, Abiri S, Haim A, Nir J, Rachmiel M, Pinhas-Hamiel O. A comparison of the usage of an open-source automated insulin delivery system and the MiniMed™ 780 G system in children and adolescents with type 1 diabetes in real-world settings: the AWeSoMe study group. Endocrine 2024; 84:943-950. [PMID: 38225516 DOI: 10.1007/s12020-024-03683-w] [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: 09/09/2023] [Accepted: 12/30/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE In recent years there has been a noticeable increase in the use of advanced hybrid closed-loop systems (AHCLs) for managing type 1 diabetes (T1D) among youth. However, there is a lack of comparison between the open-source automated insulin delivery (AID) system and the MiniMed™ 780 G system (780 G). METHODS In this multi-center study, we retrospectively compared selected glycemic ranges of 26 individuals who used open-source AID and 20 individuals who used 780 G (age 11.3 years [IQR 9.3, 12.9] and 13.4 years [IQR 10.9, 16.5], respectively, p = 0.069) from system initiation to the most recent visit. RESULTS At baseline, the median HbA1c was significantly lower and the time below range (TBR)<54mg/dL was significantly higher in the open-source AID group compared to the 780 G group (6.8% [IQR 6.4, 7.1] vs. 7.4% [IQR 6.9, 8.6], p = 0.006 and (1.0% [IQR 0.5, 2.8] vs. 0.0% [0.0, 1.0], p = 0.014), respectively; the median time in range (TIR70-180mg/dL) was similar (p = 0.068). After a median duration of 10.9 months on AHCLs the reduction of HbA1c was similar ( ~ 0.3%). The time spent in the hypoglycemic ranges was longer among users of the open-source AID compared to 780 G (TBR54-70mg/dL 4.2% [IQR 2.6, 7.3] vs. 2.0% [1.0, 4.0], p = 0.005) and TBR<54mg/dL 1.1% [IQR 0.4, 2.3] vs. 0.0 [0.0, 1.0], p = 0.001). CONCLUSIONS Both AHCLs similarly improved HbA1c and TIR70-180mg/dL. The open-source AID youth had better glycemic control but spent longer time in the hypoglycemic range. These findings must be considered when choosing the use of AHCL technologies.
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Affiliation(s)
- Zohar Landau
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Yael Lebenthal
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Kineret Mazor-Aronovitch
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Avivit Brener
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noah Levek
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Talia Jacobi-Polishook
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Endocrinology Unit, Shamir (Assaf Harofeh) Medical Center, Tzrifin, 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
| | - Shirly Abiri
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Endocrine and Diabetes Unit, E. Wolfson Medical Center, Holon, Israel
| | - Alon Haim
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Pediatric Endocrinology and Metabolic Unit, Soroka University Medical Center, Beer Sheva, Israel
| | - Judith Nir
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Endocrinology Unit, Shamir (Assaf Harofeh) Medical Center, Tzrifin, Israel
| | - Marianna Rachmiel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Endocrinology Unit, Shamir (Assaf Harofeh) Medical Center, Tzrifin, Israel
| | - Orit Pinhas-Hamiel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat-Gan, Israel
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Lablanche S, Delagenière J, Jalbert M, Sonnet E, Benichou M, Arnold N, Spiteri A, Le Berre JP, Renard E, Chevalier N, Borot S, Bonnemaison E, Coffin C, Teissier MP, Benhamou PY, Borel JC, Penfornis A, Joubert M, Kessler L. 12-Month Real-Life Efficacy of the MiniMed 780G Advanced Closed-Loop System in Patients Living with Type 1 Diabetes: A French Observational, Retrospective, Multicentric Study. Diabetes Technol Ther 2024; 26:426-432. [PMID: 38236643 DOI: 10.1089/dia.2023.0414] [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: 02/10/2024]
Abstract
Aim: To evaluate the evolution of glycemic outcomes in patients living with type 1 diabetes (T1D) after 1 year of use of the MiniMed 780G advanced hybrid closed-loop (AHCL) system. Methods: We conducted an observational, retrospective, multicentric study in 20 centers in France. The primary objective was to evaluate the improvement in glycemic control after 1-year use of AHCL. The primary endpoint was the variation of time in range (TIR) between pre-AHCL and after 1-year use of AHCL. Secondary objectives were to analyze the glycemic outcomes after 3, 6, and 12 months of AHCL use, the safety, and the long-term observance of AHCL. Results: Two hundred twenty patients were included, and 200 were analyzed for the primary endpoint. 92.7% of patients continued to use AHCL. After 1 year of use of AHCL, TIR was 72.5% ± 10.6% (+9.1%; 95% confidence interval [CI] [7.6-10.5] compared to pre-AHCL initiation, P < 0.001), HbA1c 7.1% ± 0.7% (-0.5%; 95% CI [-0.6 to -0.4]; P < 0.001), time below range 2.0% [1.0; 3.0] (0.0% [-2.0; 0.0], P < 0.001), and time above range 24.8% ± 10.9% (-7.3%; 95% CI [-8.8 to -5.7]; P < 0.001). More patients achieved the glycemic treatment goals of HbA1c <7.0% (45.1% vs. 18.1%, P < 0.001) and TIR >70% (59.0% vs. 29.5% P < 0.001) when compared with pre-AHCL. Five patients experienced severe hypoglycemia events and two patients experienced ketoacidosis. Conclusion: After 1 year of use of AHCL, people living with T1D safely improved their glucose control and a higher proportion of them achieved optimal glycemic control.
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Affiliation(s)
- Sandrine Lablanche
- Grenoble Alpes Univeristy, Grenoble Alpes University Hospital, Endocrinology-Diabetology-Nutrition Department, University, Saint-Martind'Heres, France
| | - Johanna Delagenière
- Grenoble Alpes Univeristy, Grenoble Alpes University Hospital, Endocrinology-Diabetology-Nutrition Department, University, Saint-Martind'Heres, France
| | - Manon Jalbert
- Grenoble Alpes Univeristy, Grenoble Alpes University Hospital, Endocrinology-Diabetology-Nutrition Department, University, Saint-Martind'Heres, France
| | - Emmanuel Sonnet
- Endocrinology-Diabetology Department, Brest University Hospital, Brest, France
| | - Muriel Benichou
- Endocrinology-Diabetology Department, Perpignan Hospital, Perpignan, France
| | | | - Anne Spiteri
- Pediatric Department, Grenoble Alpes University Hospital, Saint-Martin-d'Heres, France
| | | | - Eric Renard
- Endocrinology-Diabetology Department, Montpellier University Hospital, Montpellier, France
| | - Nicolas Chevalier
- Endocrinology-Diabetology Department, Nice University Hospital, Nice, France
| | - Sophie Borot
- Endocrinology-Diabetology Department, Jean-Minjoz University Hospital, Besançon, France
| | | | - Christine Coffin
- Endocrinology-Diabetology Department, Périgueux Hospital, Périgueux, France
| | | | - Pierre Yves Benhamou
- Grenoble Alpes Univeristy, Grenoble Alpes University Hospital, Endocrinology-Diabetology-Nutrition Department, University, Saint-Martind'Heres, France
| | | | - Alfred Penfornis
- Endocrinology-Diabetology Department, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
| | - Michael Joubert
- Diabetes Care Unit, Caen University Hospital, UNICAEN, Caen, France
| | - Laurence Kessler
- Endocrinology-Diabetology Department, Strasbourg University Hospital, Strasbourg, France
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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.
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Affiliation(s)
| | - Ana Chico
- Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Carmen Quirós
- Hospital Universitari Mutua de Terrassa, Barcelona, Spain
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Mingorance Delgado A, Lucas F. The Tandem Control-IQ advanced hybrid system improves glycemic control in children under 18 years of age with type 1 diabetes and night rest in caregivers. ENDOCRINOL DIAB NUTR 2023; 70 Suppl 3:27-35. [PMID: 37598004 DOI: 10.1016/j.endien.2023.08.005] [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: 05/20/2022] [Accepted: 06/12/2022] [Indexed: 08/21/2023]
Abstract
OBJECTIVE To determine the impact of switching from the predictive low glucose suspend (PLGS) system to the advanced hybrid Tandem Control-IQ system on glucometrics and glycosylated haemoglobin (HbA1c) at one year. To assess the impact on the quality of life perceived by parents. METHOD Prospective study in 71 patients aged 6-18 years with type 1 diabetes (DM1), in treatment with PLGS, who switched to an advanced hybrid system. Glucometric data were collected before the change, at 4 and 8 weeks, and at one year of use; HbA1c before the change and after one year. The Diabetes Impact and Devices Satisfaction (DIDS) questionnaire was used at weeks 4 and 8. RESULTS An increase in time in range (TIR) was observed with a median of 76% (P<.001) at 4 weeks, which was maintained after one year (+8% in the total group). Overall, 73.24% of patients achieved a TIR above 70%. The subgroup with an initial TIR of less than 56% increased it by 14.4%. After one year there was a 0.3% reduction in HbA1c. Level 1 hypoglycaemia, level 1 and level 2 hyperglycaemia, mean glucose (GM) and coefficient of variation (CV) decreased. Auto mode stayed on 97% of the time and no dropouts occurred. Caregivers had a perception of better glycaemic control and less need to monitor blood glucose variations during the night. None of them would switch back to the previous system and they feel safe with the new system. CONCLUSIONS The Tandem Control-IQ advanced hybrid system was shown to be effective one year after its implementation with improvement in all glucometric parameters and HbA1c, as well as night-time rest in caregivers.
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Affiliation(s)
- Andrés Mingorance Delgado
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL) - Diabetes y enfermedades metabólicas asociadas, Alicante, Spain; Unidad de Endocrinología y Diabetes Pediátrica, Servicio de Pediatría, Hospital General Universitario Dr. Balmis, Alicante, Spain.
| | - Fernando Lucas
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL) - Diabetes y enfermedades metabólicas asociadas, Alicante, Spain; Unidad de Diabetes, Servicio de Endocrinología, Hospital General Universitario Dr. Balmis, Alicante, 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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Almurashi AM, Rodriguez E, Garg SK. Emerging Diabetes Technologies: Continuous Glucose Monitors/Artificial Pancreases. J Indian Inst Sci 2023; 103:1-26. [PMID: 37362851 PMCID: PMC10043869 DOI: 10.1007/s41745-022-00348-3] [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: 10/18/2022] [Accepted: 11/04/2022] [Indexed: 03/30/2023]
Abstract
Over the past decade there have been many advances in diabetes technologies, such as continuous glucose monitors (CGM s), insulin-delivery devices, and hybrid closed loop systems . Now most CGMs (Medtronic-Guardian, Dexcom-G6, and Abbott-Libre-2) have MARD values of < 10%, in contrast to two decades ago when the MARD used to be > 20%. In addition, the majority of the new CGMs do not require calibrations, and the latest CGMs last for 10-14 days. An implantable 6-months CGM by Eversense-3 is now approved in the USA and Europe. Recently, the FDA approved Libre 3 which provides real-time glucose values every minute. Even though it is approved as an iCGM it is not interoperable with automatic-insulin-delivery (AID) systems. The newer CGMs that are likely to be launched in the next few months in the USA include the 10-11 days Dexcom G7 (60% smaller than the existing G6), and the 7-days Medtronic Guardian 4. Most of the newer CGM have several features like automatic initialization, easy insertion, predictive alarms, and alerts. It has also been noticed that an arm insertion site might have better accuracy than abdomen or other sites, like the buttock for kids. Lag time between YSI and different sensors have been reported differently, sometimes it is down to 2-3 min; however, in many instances, it is still 15-20 min, especially when the rate of change of glucose is > 2 mg/min. We believe that in the next decade there will be a significant increase in the number of people who use CGM for their day-to-day diabetes care.
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Affiliation(s)
- Abdulhalim M. Almurashi
- Barbara Davis Center for Diabetes, University of Colorado Denver, 1775 Aurora Ct, Rm 1324, Aurora, CO 80045 USA
- Madinah Health Cluster, Madinah, Saudi Arabia
| | - Erika Rodriguez
- Barbara Davis Center for Diabetes, University of Colorado Denver, 1775 Aurora Ct, Rm 1324, Aurora, CO 80045 USA
| | - Satish K. Garg
- Barbara Davis Center for Diabetes, University of Colorado Denver, 1775 Aurora Ct, Rm 1324, Aurora, CO 80045 USA
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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.
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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
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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.
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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
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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.
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Bombaci B, Passanisi S, Alibrandi A, D’Arrigo G, Patroniti S, Averna S, Salzano G, Lombardo F. One-Year Real-World Study on Comparison among Different Continuous Subcutaneous Insulin Infusion Devices for the Management of Pediatric Patients with Type 1 Diabetes: The Supremacy of Hybrid Closed-Loop Systems. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191610293. [PMID: 36011925 PMCID: PMC9408433 DOI: 10.3390/ijerph191610293] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 05/30/2023]
Abstract
Since their advent in daily clinical practice, continuous subcutaneous insulin infusion (CSII) systems have been increasingly improved, leading to a high percentage of both adult and pediatric patients with diabetes now using insulin pumps. Different types of CSII systems are currently available, which are characterized by different settings and technical features. This longitudinal observational study aims to evaluate real-word glycemic outcomes in children and adolescents with type 1 diabetes using three different CSII devices: hybrid closed-loop (HCL) systems, predictive low glucose (PLGS) systems, and non-automated insulin pumps. The secondary objective was to identify clinical variables that may significantly influence the achievement of therapeutic goals in our study cohort. One-hundred-and-one patients on CSII therapy attending our pediatric diabetes center were enrolled. When compared with the non-automated group, patients using HCL systems showed higher levels of time in target glucose range (p = 0.003) and lower glucose variability (p = 0.008). Similarly, we found significantly better glucose metrics in HCL users in comparison to PLGS patients (time in range p = 0.008; coefficient of variation p = 0.009; time above 250 mg/dL p = 0.007). Multiple linear regression models showed that HCL systems (time in range p < 0.001) and high daily percentage of glycemic sensor use (time in range p = 0.031) are predictors for good glycemic control. The introduction and increasing availability of novel technologies for diabetes represent a promising strategy to improve glycemic control and quality of life in pediatric patients with type 1 diabetes. Our real-world data confirm the superiority of HCL systems in terms of improvement of time spent in the target glucose range, prevention of hypoglycemia, and reduction of glycemic variability.
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Affiliation(s)
- Bruno Bombaci
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, Via Consolare Valeria 1, 98124 Messina, Italy
| | - Stefano Passanisi
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, Via Consolare Valeria 1, 98124 Messina, Italy
| | - Angela Alibrandi
- Unit of Statistical and Mathematical Sciences, Department of Economics, University of Messina, 98124 Messina, Italy
| | - Giulia D’Arrigo
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, Via Consolare Valeria 1, 98124 Messina, Italy
| | - Serena Patroniti
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, Via Consolare Valeria 1, 98124 Messina, Italy
| | - Simona Averna
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, Via Consolare Valeria 1, 98124 Messina, Italy
| | - Giuseppina Salzano
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, Via Consolare Valeria 1, 98124 Messina, Italy
| | - Fortunato Lombardo
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, Via Consolare Valeria 1, 98124 Messina, Italy
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11
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Mingorance Delgado A, Lucas F. El sistema híbrido avanzado Tandem Control-IQ mejora el control glucémico en menores de 18 años con diabetes tipo 1 y el descanso nocturno de los cuidadores. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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12
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Pintaudi B, Gironi I, Nicosia R, Meneghini E, Disoteo O, Mion E, Bertuzzi F. Minimed Medtronic 780G optimizes glucose control in patients with type 1 diabetes mellitus. Nutr Metab Cardiovasc Dis 2022; 32:1719-1724. [PMID: 35599092 DOI: 10.1016/j.numecd.2022.03.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/26/2022] [Accepted: 03/31/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND AIMS The new advanced hybrid closed loop insulin infusion systems have the potential to significantly improve glycaemic control. The aim of this study was to evaluate the effectiveness of the Minimed 780G system in 59 patients with type 1 diabetes. METHODS AND RESULTS Glucose control obtained by using the system in automatic mode at 1-2 months of activation, at 2-4 months, at 4-6 months, and beyond 6 month was compared with those obtained with the system in manual mode. A significant improvement in time-in-range and in time-above-range throughout the follow-up was observed, as well as a significant reduction in time-below-range (<54 mg/dl) after 6 months, a significant reduction of the glucose variability and of HbA1c. After switching the mode, all target percentages lied on the average within the recommended ranges by literature consensus and no severe hypoglycemia nor ketoacidosis episodes were recorded. CONCLUSION The Minimed 780G allowed a rapid and progressive improvement of the overall glucose control.
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Affiliation(s)
- Basilio Pintaudi
- SC Diabetologia, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Ilaria Gironi
- SC Diabetologia, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Riccardo Nicosia
- SC Diabetologia, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Elena Meneghini
- SC Diabetologia, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Olga Disoteo
- SC Diabetologia, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Elena Mion
- SC Diabetologia, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Federico Bertuzzi
- SC Diabetologia, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
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13
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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.
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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
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Abstract
PURPOSE OF REVIEW Closed-loop insulin pump systems (artificial pancreas) represent the cutting edge of insulin delivery technology. There are only a few systems currently approved for use in the USA: the MiniMed 670G/770G (which share an algorithm), t:slim X2 Control IQ, and the Omnipod 5. We review these systems and look into the future of the technology. RECENT FINDINGS All of the approved closed-loop insulin pump systems have demonstrated in multicenter prospective trials improvements in time in range, hemoglobin A1c, and time spent in hypoglycemia. The newer systems have also improved time spent in automation. Comparisons between the systems with regard to glycemic control are difficult to make due to differences in clinical trial design, but there are notable differences in the user experience between systems. The past few years have been a time of exponential development in the field of closed-loop insulin pump systems. However, more research is needed to provide full automation of these systems without any need for information from the user.
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Affiliation(s)
- Keren Zhou
- Endocrinology and Metabolism Institute, Cleveland Clinic, 9500 Euclid Avenue, F20, Cleveland, OH, 44195, US.
| | - Diana Isaacs
- Endocrinology and Metabolism Institute, Cleveland Clinic, 9500 Euclid Avenue, F20, Cleveland, OH, 44195, US
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15
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Bassi M, Strati MF, Andreottola V, Calevo MG, d’Annunzio G, Maghnie M, Minuto N. To sleep or not to sleep: An Italian Control-IQ-uestion. Front Endocrinol (Lausanne) 2022; 13:996453. [PMID: 36578959 PMCID: PMC9790911 DOI: 10.3389/fendo.2022.996453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 11/18/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Tandem Control-IQ is an advanced hybrid closed loop (AHCL) system with a Sleep Activity Mode to intensify glycemic control overnight. The aim of the study is to evaluate the effectiveness of using Sleep Mode or not among Tandem Control-IQ users. RESEARCH DESIGN AND METHODS We performed a retrospective Tandem Control-IQ data download for patients followed at IRCCS G. Gaslini Pediatric Diabetes Centre. We divided the patients into group 1 (Sleep Mode users) and group 2 (non-users) and compared their overall glycemic data, particularly during nighttime. RESULTS Group 1 (n = 49) does not show better nocturnal glycemic control as expected when compared with group 2 (n = 34). Group 2 shows a nighttime TIR% of 69.50 versus 66.25 (p = 0.20). Only the patients who do not use Sleep Mode and with sensor and automatic mode use ≥90% reached TIR >70% during nighttime, as well as lower nocturnal TAR% (18.80 versus 21.78, p = 0.05). CONCLUSIONS This is the first study that evaluates the real-life effectiveness of the use of Sleep Mode in young patients with T1D. Control-IQ Sleep Activity Mode may not be as effective in Italian patients as in American patients due to the different habits.
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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, 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, Genoa, Italy
| | - Valentina Andreottola
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Maria Grazia Calevo
- Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Mohamad Maghnie
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Nicola Minuto
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- *Correspondence: Nicola Minuto,
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