Carbohydrate Tolerance Threshold for Unannounced Snacks in Children and Adolescents With Type 1 Diabetes Using an Advanced Hybrid Closed-Loop System

Tornese, Gianluca; Carletti, Claudia; Giangreco, Manuela; Nisticò, Daniela; Faleschini, Elena; Barbi, Egidio

doi:10.2337/dc21-2643

Cited by 23 publications

(10 citation statements)

References 16 publications

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“…As shown by Tornese G. et al., autocorrections allow a more liberal approach to dietary aspects of the therapy. The authors revealed that in case of not very exact carbohydrate counts or a missed meal bolus, the AHCL system helped by delivering an autocorrection dose without the patient’s intervention ( 6 ). Similar outcomes presented a study comparing glycemic control for announced and unannounced meal challenges.…”

Section: Discussionmentioning

confidence: 99%

Glycemic control in children with type 1 diabetes treated with the advanced hybrid closed loop system 2-year prospective, observational, two-center study

Seget,

Chobot,

Tarasiewicz

et al. 2024

Front. Endocrinol.

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Background and aimsMiniMed 780G is the first Advanced Hybrid Closed Loop (AHCL) system in Poland, approved in the EU in 2020. To date, observations of glycemic control up to 12 months have been published. This study aimed to analyze glycemic control and anthropometric parameters in children and adolescents with type 1 diabetes (T1D) after two years of using the AHCL system.Materials and methodsWe prospectively collected anthropometric data, pump, and continuous glucose records of fifty T1D children (9.9 ± 2.4 years, 24 (48%) boys, T1D for 3.9 ± 2.56 years) using an AHCL system. We compared the two-week AHCL records obtained after AHCL enrollment with data 6, 12, and 24 months after starting AHCL.ResultsTime in range (70-180 mg/dl) and BMI z-score did not change during the 2 years of observation (p>0.05). The percentage of autocorrection in total daily insulin increased significantly (p<0.005).ConclusionGlycemic control in the investigated group of children with T1D treated with the AHCL system for 2 years remained stable. Children in this group maintained weight and optimal metabolic control, most likely due to autocorrection boluses.

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Section: Discussionmentioning

confidence: 99%

Glycemic control in children with type 1 diabetes treated with the advanced hybrid closed loop system 2-year prospective, observational, two-center study

Seget,

Chobot,

Tarasiewicz

et al. 2024

Front. Endocrinol.

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“…One other meal announcement method has been described for the MiniMed 780G system so far. Unannounced snacks of up to 20 g of carbohydrates can avoid a difference in blood glucose of ≥50 mg/dL in pediatric MiniMed 780G users, and unannounced meals of up to 30 g of carbohydrates are safe ( 15 ). However, the MiniMed 780G system is not designed as a full closed loop system; thus, meal announcement is preferred.…”

Section: Discussionmentioning

confidence: 99%

Simplified Meal Announcement Versus Precise Carbohydrate Counting in Adolescents With Type 1 Diabetes Using the MiniMed 780G Advanced Hybrid Closed Loop System: A Randomized Controlled Trial Comparing Glucose Control

et al. 2023

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OBJECTIVE We aimed to compare glucose control in adolescents with type 1 diabetes (T1D) using the MiniMed 780G system who used simplified meal announcement with those who used precise carbohydrate counting. RESEARCH DESIGN AND METHODS This randomized controlled trial included 34 participants (age 12–18 years) with T1D who were on multiple daily injections or insulin pump and were scheduled to start using the MiniMed 780G system at Sidra Medicine in Qatar. After a 7-day run-in period, participants were randomly assigned to the fix group (simplified meal announcement by preset of three personalized fixed carbohydrate amounts) or the flex group (precise carbohydrate counting) and followed for 12 weeks. Between-group difference in time in range (TIR) was the primary end point. Secondary end points included HbA1c and other glycometrics. RESULTS During the 12-week study phase, TIR was 73.5 ± 6.7% in the fix and 80.3 ± 7.4% in the flex group, with a between-group difference of 6.8% in favor of flex (P = 0.043). Time >250 mg/dL was better in the flex group (P = 0.012), whereas HbA1c (P = 0.168), time below range (P = 0.283), and time between 180 and 250 mg/dL (P = 0.114) did not differ. CONCLUSIONS Adolescents using the MiniMed 780G system with a preset of three personalized fixed carbohydrate amounts can reach international targets of glycemic control. Therefore, it may be a valuable alternative to precise carbohydrate counting in users who are challenged by precise carbohydrate counting. Because carbohydrate counting further improves outcomes, these skills remain important for MiniMed 780G users.

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“…Petrovski et al have shown that a simplified meal announcement with a preset of different fixedcarbohydrate amounts could be used, with 67% of patients in the fix group reaching the target TIR, even with a 6.8% TIR difference in favor of the precise CHO count [15]. Bolus omission and bolus delay are very common, especially among adolescents with T1D, and even though Tornese et al observed that unannounced CHO snack of <20 g of CHO resulted in a tolerable glucose excursion in children and adolescents treated by the Medtronic MiniMed TM 780G [16], it is of utmost importance to ensure patients and their families receive retraining in CHO counting periodically, as well as verifying that meals are announced, and if the insulin/CHO settings are still reliable or if it is the algorithm that does the job. Bolus omission seems an issue that does not concern the study cohort, and the number of meals increased over time.…”

Section: Discussionmentioning

confidence: 99%

Glycemic Control, Basal/Bolus Distribution, BMI and Meal Management in Children and Adolescents with Type 1 Diabetes and Advanced Hybrid Closed Loop

Piccini,

Felicioni,

Pessina

et al. 2023

Nutrients

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Evidence about the impact of advanced hybrid closed loop (AHCL) on body mass index (BMI) and eating habits in children with type 1 diabetes (T1D) is lacking. This real-world study aimed at evaluating glycemic control, BMI, meals and basal/bolus distribution in young subjects with T1D treated by AHCL. Glycemic metrics, HbA1c, basal/bolus distribution, meals/day, BMI, total daily dose (TDD), and carbohydrates/kg (CHO/kg) have been evaluated in 83 subjects, aged 13 ± 4.5 years, in manual mode, 3 and 6 months after auto-mode. Time in range (TIR) increased after 3 months, exceeding the target of 70% and was maintained at 6 months. While coefficient of variation (CV) did not change, the glucose management indicator (GMI) decreased in auto-mode (6.7 ± 0.3 vs. 7.1 ± 0.5%; p < 0.001), as well as HbA1c. Basal proportion decreased in favor of boluses (38.3 ± 7.3 vs. 43.6 ± 10.9%; p < 0.001). Meals increased at 3 and 6 months (4.4 ± 1.2 vs. 5.0 ± 1.5, p 0.002 and 5.1 ± 1.7, p < 0.001), as well as TDD/kg, without changes in BMI and CHO consumed. No differences in meal composition have arisen from food diaries. In conclusion, AHCL ensured the achievement and maintenance of target TIR in young T1D subjects. The number of meals, TDD, and insulin bolus proportion increased over time, but BMI remained stable.

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Carbohydrate Tolerance Threshold for Unannounced Snacks in Children and Adolescents With Type 1 Diabetes Using an Advanced Hybrid Closed-Loop System

Cited by 23 publications

References 16 publications

Glycemic control in children with type 1 diabetes treated with the advanced hybrid closed loop system 2-year prospective, observational, two-center study

Glycemic control in children with type 1 diabetes treated with the advanced hybrid closed loop system 2-year prospective, observational, two-center study

Simplified Meal Announcement Versus Precise Carbohydrate Counting in Adolescents With Type 1 Diabetes Using the MiniMed 780G Advanced Hybrid Closed Loop System: A Randomized Controlled Trial Comparing Glucose Control

Glycemic Control, Basal/Bolus Distribution, BMI and Meal Management in Children and Adolescents with Type 1 Diabetes and Advanced Hybrid Closed Loop

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