Increased proportion of time in hybrid closed‐loop “Auto Mode” is associated with improved glycaemic control for adolescent and young patients with adult type 1 diabetes using the MiniMed 670G insulin pump

Duffus, Sara H.; Ta'ani, Zain Al; Slaughter, James C.; Niswender, Kevin D.; Gregory, Justin M.

doi:10.1111/dom.13912

Cited by 45 publications

(36 citation statements)

References 9 publications

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“…This high percentage use of automation and no dropout rates can be attributed to the specific selection/initiation protocol including the initial use of the system as a sensor alone for 7 days, although the relative contribution of each component cannot be determined from the study. The study confirmed previous conclusions, that increased Auto Mode usage is associated with lower HbA1c and increased TIR, resulting in that patients with both higher sensor wear times and increased Auto Mode usage had incrementally lower HbA1c than patients with lower sensor wear time and less Auto Mode usage [17]. Our data showed high Auto Mode usage of 85.6% at 1 year, which is higher than 51% at 6 months after HCL initiation [13].…”

Section: Discussionsupporting

confidence: 90%

One-year experience of hybrid closed-loop system in children and adolescents with type 1 diabetes previously treated with multiple daily injections: drivers to successful outcomes

et al. 2020

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Objective To evaluate the effect of a 1-year hybrid closed-loop (HCL) system on glycemic control in children and adolescents with type 1 diabetes (T1D) previously treated with multiple daily injections (MDI). Methods This was a 1-year observational study, as a continuation of the previous 3 months prospective study of pediatric patients with T1D conducted at Sidra Medicine in Qatar. The study enrolled individuals aged 7–18 years with T1D > 1 year, on MDI with self-monitoring of blood glucose or continuous glucose monitoring, with no prior pump experience, and with an HbA1c level < 12.5% (< 113 mmol/mol). After the first 3 months of HCL use, patients were followed at 6, 9 and 12 months, where HbA1c was obtained and pump data were collected. Results All 30 participants (age 10.24 ± 2.6 years) who initiated HCL completed 12 months of HCL system use in Auto Mode. The participants used the sensor 88.4 ± 6.5% of the time with Auto Mode usage 85.6 ± 7.4% during 12 months of HCL system use. HbA1c decreased from 8.2 ± 1.4% (66 ± 15.3 mmol/mol) at baseline, to 6.7 ± 0.5% (50 ± 5.5 mmol/mol) at 3 months (p = 0.02) and remained stable to 7.1 ± 0.6 (54 ± 6.6 mmol/mol) at 12 months (p = 0.02). TIR (70–180 mg/dL) increased from 46.9% at baseline to 71.9% at 1 month and remained above 70% during the 12 months of HCL use. Conclusion HCL system (MiniMed 670G) in children and adolescents previously treated with MDI significantly improves glycemic outcomes (HbA1c and Time in Ranges) immediately during the first month. This improved glycemic control was maintained over the 1 year following Auto Mode initiation.

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Section: Discussionsupporting

confidence: 90%

One-year experience of hybrid closed-loop system in children and adolescents with type 1 diabetes previously treated with multiple daily injections: drivers to successful outcomes

et al. 2020

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“… 20 Prior studies of different systems have pointed to the need to keep closed-loop automation active, with improved TIR and decreased A1c correlating with time spent with closed-loop automation active. 21 A considerable amount of literature has been developed on how to help patients with diabetes use AID systems, particularly related to keeping closed-loop automation active. 22 , 23 Control-IQ technology has only one reason for automation to cease (loss of CGM connectivity for 20 or more minutes), and automatically resumes automation as soon as valid CGM values are received with no need for the user to switch on or activate automation in any way.…”

Section: Resultsmentioning

confidence: 99%

Real-World Patient-Reported Outcomes and Glycemic Results with Initiation of Control-IQ Technology

Pinsker

Müller

Constantin

et al. 2021

Diabetes Technology & Therapeutics

108

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Background: The t:slim X2Ô insulin pump with Control-IQÔ technology, an advanced hybrid closed-loop system, became available in the United States in early 2020. Real-world outcomes with use of this system have not yet been comprehensively reported. Methods: Individuals with type 1 diabetes (T1D) (‡14 years of age) who had ‡21 days of pump usage data were invited via email to participate. Participants completed psychosocial questionnaires (Technology Acceptance Scale [TAS], well-being index [WHO-5], and Diabetes Impact and Devices Satisfaction [DIDS] scale) at timepoint 1 (T1) (at least 3 weeks after starting Control-IQ technology) and the DIDS and WHO-5 at timepoint 2 (T2) (4 weeks from T1). Patient-reported outcomes (PROs) and glycemic outcomes were reviewed at each timepoint. Results: Overall, 9,085 potentially eligible individuals received the study invite. Of these, 3,116 consented and subsequently 1,435 participants completed questionnaires at both T1 and T2 and had corresponding glycemic data available on the t:connect Ò web application. Time in range was 78.2% (70.2%-85.1%) at T1 and 79.2% (70.3%-86.2%) at T2. PROs reflected high device-related satisfaction and reduced diabetes impact at T2. Factors contributing to high trust in the system included sensor accuracy, improved diabetes control, reduction in extreme blood glucose levels, and improved sleep quality. In addition, participants reported improved quality of life, ease of use, and efficient connectivity to the continuous glucose monitoring system as being valuable features of the system. Conclusions: Continued real-world use of the t:slim X2 pump with Control-IQ technology showed improvements in psychosocial outcomes and persistent achievement of recommended TIR glycemic outcomes in people with T1D.

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“…Some education is common to most novel diabetes technology, for example, the need to count carbohydrates and deliver meal bolus with food. In addition there is also a need for specific education with hybrid closed‐loop systems, for example, how to deal with and minimize "automode exits", how to deal with connection problems software issues and updates, and how to safely use standard sensor‐augmented pump therapy at times when closed loop is not working for whatever reason 29,30 . Users and healthcare professionals also need to be educated about interpretation of data outputs from various closed‐loop software systems and how to adjust existing pump settings based on closed‐loop performance.…”

Section: Discussionmentioning

confidence: 99%

Hybrid closed‐loop therapy: Where are we in 2021?

Leelarathna

Choudhary

Wilmot

et al. 2020

Diabetes Obesity Metabolism

107

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Hybrid closed‐loop systems are characterized by the coexistence of algorithm‐driven automated insulin delivery combined with manual mealtime boluses. Used correctly, these insulin delivery systems offer better glucose control and reduced risk of hypoglycaemia and represent the most advanced form of insulin delivery available for people with type 1 diabetes. The aim of this paper was to compare the currently available commercial hybrid closed‐loop systems in the UK: the Medtronic 670G/780G, Tandem t:slim X2 Control IQ and CamAPS FX systems. The Medtronic 670G/780G systems use Guardian 3 sensor (7‐day use, two to four calibrations per day), while Tandem and CamAPS systems use the calibration‐free Dexcom G6 sensor (10 days). The CamAPS system is available as an android app, whereas the other two systems have the algorithm embedded in the insulin pump. During pivotal studies, depending on the study population and baseline glycated haemoglobin level, these systems achieve a time spent in the target range 3.9 to 10 mmol/L (70 to 180 mg/dL) of 65% to 76% with low burden of hypoglycaemia. All three systems allow a higher glucose target for announced exercise, while the Tandem system offers an additional night‐time tighter target. The CamAPS system offers fully customizable glucose targets and is the only system licensed for use during pregnancy. Additional education is required for both users and healthcare professionals to harness the best performance from these systems as well as to troubleshoot when “automode exits” occur. We provide consensus recommendations to develop pragmatic pathways to guide patients, clinicians and commissioners in making informed decisions on the appropriate use of the diabetes technology.

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Increased proportion of time in hybrid closed‐loop “Auto Mode” is associated with improved glycaemic control for adolescent and young patients with adult type 1 diabetes using the MiniMed 670G insulin pump

Cited by 45 publications

References 9 publications

One-year experience of hybrid closed-loop system in children and adolescents with type 1 diabetes previously treated with multiple daily injections: drivers to successful outcomes

One-year experience of hybrid closed-loop system in children and adolescents with type 1 diabetes previously treated with multiple daily injections: drivers to successful outcomes

Real-World Patient-Reported Outcomes and Glycemic Results with Initiation of Control-IQ Technology

Hybrid closed‐loop therapy: Where are we in 2021?

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