OR14-5 Challenges in implementing Hybrid Closed Loop Insulin Pump Therapy (medtronic 670g) In A 'Real World' Clinical Setting.

Goodwin, Gregory; Waldman, Gretchen; Lyons, Justine; Oladunjoye, Adeolu O; Steil, Garry M.

doi:10.1210/js.2019-or14-5

Cited by 12 publications

(19 citation statements)

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“…There is substantial evidence that HCL systems have potential to improve overall glycemic control, with many controlled trials reporting increased time in target range and reduction in hyperglycemia and hypoglycemia . However, individuals need to use HCL consistently to realize these benefits, and emerging observational data of 670G HCL use in the real‐world suggests a high risk for HCL discontinuation as well as attrition in time spent in HCL for those who continue using it…”

Section: Discussionmentioning

confidence: 99%

“…Data from our group's observational study presented elsewhere indicate that Auto Mode use and sensor wear decreased over the first 6 mo of use, and 30% of the youth discontinued HCL altogether . In addition, other prospective observational studies have reported 35% and 38% of patients discontinuing Auto Mode use in the first 9‐12 mo of system use . The reasons for HCL discontinuation are not well documented, with one report indicating sensor issues and difficulty obtaining supplies as primary reasons .…”

Section: Introductionmentioning

confidence: 99%

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Real world hybrid closed‐loop discontinuation: Predictors and perceptions of youth discontinuing the 670G system in the first 6 months

et al. 2020

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Objective: To describe predictors of hybrid closed loop (HCL) discontinuation and perceived barriers to use in youth with type 1 diabetes.Subjects: Youth with type 1 diabetes (eligible age 2-25 y; recruited age 8-25 y) who initiated the Minimed 670G HCL system were followed prospectively for 6 mo in an observational study.Research Design and Methods: Demographic, glycemic (time-in-range, HbA1c), and psychosocial variables [Hypoglycemia Fear Survey (HFS); Problem Areas in Diabetes (PAID)] were collected for all participants. Participants who discontinued HCL (<10% HCL use at clinical visit) completed a questionnaire on perceived barriers to HCL use.Results: Ninety-two youth (15.7 ± 3.6 y, HbA1c 8.8 ± 1.3%, 50% female) initiated HCL, and 28 (30%) discontinued HCL, with the majority (64%) discontinuing between 3 and 6 mo after HCL start. Baseline HbA1c predicted discontinuation (P = .026) with the odds of discontinuing 2.7 times higher (95% CI: 1.123, 6.283) for each 1% increase in baseline HbA1c. Youth who discontinued HCL rated difficulty with calibrations, number of alarms, and too much time needed to make the system work as the most problematic aspects of HCL. Qualitatively derived themes included technological difficulties (error alerts, not working correctly), too much work (calibrations, fingersticks), alarms, disappointment in glycemic control, and expense (cited by parents).Conclusions: Youth with higher HbA1c are at greater risk for discontinuing HCL than youth with lower HbA1c, and should be the target of new interventions to support device use. The primary reasons for discontinuing HCL relate to the workload required to use HCL. K E Y W O R D Sartificial pancreas, continuous glucose monitor, insulin pump, hybrid closed loop, pediatrics, type 1 diabetes Type 1 diabetes (T1D), typically diagnosed in childhood 1,2 requires lifelong replacement of exogenous insulin, and monitoring of glucose levels to minimize hypoglycemia and hyperglycemia. 3 Long-term consequences of suboptimal glycemic control include both microvascular and macrovascular complications that increase morbidity and mortality for individuals with T1D. 3 Sub-optimal glycemic control also increases risk of emergent complications such as hypoglycemic seizures and loss of consciousness, and diabetic ketoacidosis or diabetic coma. 4,5 The T1D Exchange Registry recently showed that in the United States only 21% of adults and 17% of youth with T1D meet hemoglobin A1c (HbA1c) goals set forth by the American Diabetes Association, signifying the need for improvements in treatment and care of T1D. 6

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Real world hybrid closed‐loop discontinuation: Predictors and perceptions of youth discontinuing the 670G system in the first 6 months

et al. 2020

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“…Cited reasons for discontinuation included calibration requirements, problems with sensor durability or adhesion, skin irritation and forced exits from Auto Mode . The percentage time spent in Auto Mode was also highly variable, ranging from 10% to 90% . Although the percentage of time in Auto Mode was comparatively higher in the pivotal 670G trial, Auto Mode time declined from a peak of 87% after the first 7 days of use to 72% at the 3‐month endpoint in the adolescent and young adult subanalysis .…”

Section: Discussionmentioning

confidence: 99%

“…7 Cited reasons for discontinuation included calibration requirements, problems with sensor durability or adhesion, skin irritation and forced exits from Auto Mode. 7 The percentage time spent in Auto Mode was also highly variable, ranging from 10% to 90%. 7 Although the percentage of time in Measures of dietary intake were also significant covariates in the multivariable regression models.…”

Section: Additional Bivariate Analyses Of Variables Of Interest Are Dmentioning

confidence: 99%

“…7 The percentage time spent in Auto Mode was also highly variable, ranging from 10% to 90%. 7 Although the percentage of time in Measures of dietary intake were also significant covariates in the multivariable regression models. In the HbA1c analysis, greater carbohydrate consumption was associated with lower HbA1c.…”

Section: Additional Bivariate Analyses Of Variables Of Interest Are Dmentioning

confidence: 99%

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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

Duffus

Ta'ani

Slaughter

et al. 2019

Diabetes Obesity Metabolism

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The Medtronic MiniMed 670G system delivers insulin to patients with type 1 diabetes mellitus (T1DM) using either its hybrid closed‐loop (HCL) “Auto Mode” feature or an open‐loop mode. In this retrospective, cross‐sectional analysis, we quantified the association between time in Auto Mode and both haemoglobin A1c (HbA1c) and time in range (TIR, sensor glucose 70–180 mg/dL) among 96 paediatric and young adult patients with T1DM. The median percentage time in Auto Mode was 38.5% (interquartile range 0%–64%). The percentage time in Auto Mode significantly correlated with HbA1c after adjustment for covariables (β = −0.008, P = 0.014). Each daily 3.4‐h increase in Auto Mode time was associated with a 0.1% decrease in HbA1c. Auto Mode time was also correlated with TIR after adjustment for covariables (β = 0.14, P = 0.02): for each daily 8.6‐h increase in Auto Mode time, TIR increased by 5%. While Auto Mode use was low, increased time in Auto Mode was associated with a significantly lower HbA1c and increased TIR. These findings emphasize the importance of identifying strategies to improve the ease of use of HCL systems.

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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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OR14-5 Challenges in implementing Hybrid Closed Loop Insulin Pump Therapy (medtronic 670g) In A 'Real World' Clinical Setting.

Cited by 12 publications

References 0 publications

Real world hybrid closed‐loop discontinuation: Predictors and perceptions of youth discontinuing the 670G system in the first 6 months

Real world hybrid closed‐loop discontinuation: Predictors and perceptions of youth discontinuing the 670G system in the first 6 months

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

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

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