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

Abstract

<p> </p> <p><strong>Objective</strong>. We aimed to compare glucose control in adolescents with Type 1 Diabetes (T1D) on MiniMed 780G system that used simplified meal announcement to those that used precise carbohydrate counting. </p> <p><strong>Research Design and Methods.</strong> This randomized controlled trial included 34 participants (12-18 years) with T1D that were on multiple daily injections or insulin pump and were scheduled to start using MiniMed 780G system at Sidra Medicine, Qatar. After a 7-day run-in period, participants were randomly assigned to the Fix group (simplified meal announcement by preset of 3 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 endpoint. Secondary endpoints included HbA1c and other glycometrics.</p> <p><strong>Results</strong>. 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 above 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 180-250 mg/dL (p=0.114) did not differ. </p> <p><strong>Conclusion. </strong>Adolescents on the MiniMed 780G system using a preset of 3 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. </p>

Impact of an online nutrition management application service on glycaemic management in individuals with diabetes: A propensity‐score‐matched retrospective cohort study

“…Additionally, the functionality of the app in specifying carbohydrate quantities aligns with effective glycaemic management strategies, such as carbohydrate counting. 35 A subjective questionnaire was used to define app use, whilst simultaneously considering both the frequency of logins and engagement with functionalities, such as recipe browsing. This approach recognizes even minimal usage as potentially beneficial in influencing dietary behaviours.…”

Adaptive bolus calculators for people with type 1 diabetes: A systematic review

“…There is potential for adaptive algorithms to adjust doses based on simplified meal announcements in HCL systems. Petrovski et al 43 found that, for adolescents using an HCL system (n = 34), although the group undertaking precise carbohydrate counting had a greater TIR and lower TAR, the majority of participants in the group using simplified meal announcements (three preset fixed carbohydrate amounts) achieved the international targets for glycaemic control. Real-world data suggest there is not a significant improvement in TIR in adolescent or adult users of HCL systems as the number of distinct ICRs used per day increases.…”