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

Abstract

BackgroundInformation 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 methodsFor 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.ResultsThe 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).ConclusionDuring 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.

Real‐world performance of the MiniMed 780G advanced hybrid closed loop system in Latin America: Substantial improvement in glycaemic control with each technology iteration of the MiniMed automated insulin delivery system

“…The long-term sustainability of the glycaemic control as obtained with the MiniMed 780G system has been reported before as well, both in clinical trials 5,17,18 and in real-world studies. 7,10 The excellent glycaemic control and the sustainability thereof as achieved in this study may contribute to facilitate adoption of diabetes technology in Latin America.…”

“…These results are in line with a previous real‐world study from Arrieta et al, 7 who also showed that >75% of mainly European MiniMed 780G system users aged ≤15 years achieved international consensus criteria, mirroring the outcomes of the population aged >15 years. The long‐term sustainability of the glycaemic control as obtained with the MiniMed 780G system has been reported before as well, both in clinical trials 5,17,18 and in real‐world studies 7,10 …”

Impact on glucometric variables and quality of life of the advanced hybrid closed‐loop system in pediatric and adolescent type 1 diabetes

“…30 However, studies such as that of Seget et al show no changes in glycemic control once AHCL is initiated and after 1 year of follow-up (TIR 79.28% ± 8.12% vs. 80.40% ± 8.25%, p >.05). 31 With regard to these data, our study showed a significant improvement in TIR early after the change of system, which was also significant at all the cutoff points compared to baseline (Table 1). Previously, the mean TIR value of our patients did not meet the standardized values for this variable (TIR >70%), 2 and this objective was reached in the first 48 hours from initiation of the closed-loop system and was maintained throughout the evaluation through 6 months of follow-up.…”

“…Studies published in the pediatric population using this technology show a higher percentage of TIR, such as that carried out by Petrovski et al when comparing MDI + CGM versus AHCL MiniMed 780G (42.10% ± 18.70% baseline vs. 78.80% ± 6.10% at 3 months [ p <.001]) 29 or that by Bassi et al, which compared two AHCL systems (MiniMed 780G vs. Tandem‐IQ), with better results obtained with the Medtronic technology (TIR at 1 month 74.80% vs. 65.50%, respectively, p = .004) 30 . However, studies such as that of Seget et al show no changes in glycemic control once AHCL is initiated and after 1 year of follow‐up (TIR 79.28% ± 8.12% vs. 80.40% ± 8.25%, p >.05) 31 …”

Beneficial effects of automated insulin delivery over one‐year follow‐up in real life for youths and adults with type 1 diabetes irrespective of patient characteristics

“…Although, real life studies have revealed impressive results with high proportions of users who achieved international consensus with recommended TIR 70-180 mg/dl and HbA1c levels, [11][12][13][14] percentage of participants who reached target HbA1c values was higher than those reaching target GMI levels, particularly for CIQ users. This discrepancy can be explained by differences in the type of glucose sensors and algorithms, which may cause differences as much on the trend as the absolute glucose value.…”