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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] [What about the content of this article? (0)] [Affiliation(s)] [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] [What about the content of this article? (0)] [Affiliation(s)] [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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