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11-30-2022 | Artificial pancreas systems | News

Real-world data show reduced diabetes burden in young closed-loop users

Author: Eleanor McDermid


medwireNews: Real-world use of hybrid closed-loop insulin delivery is associated with improved glycemic control and sleep quality, as well as reduced fear of hypoglycemia in children and young people with type 1 diabetes, shows a UK study.

“The changes in hypoglycaemia fear and quality of sleep represent important improvements for the individuals and an important reduction in diabetes burden,” say the researchers.

The average fear of hypoglycemia score in parents or carers fell from 56.5 before the child initiated closed-loop insulin delivery to 45.2 after 6 months, and in closed-loop users older than 12 years it fell from an average of 64.9 to 57.5.

Both these changes were significant, as were reductions in the behavior and worry subscales.

For sleep, measured on the Patient Reported Outcomes Measurement Information System, the average sleep-related impairment T-score in closed-loop users older than 8 years fell from 56.6 to 54.9 and the parent proxy sleep disturbance T-score fell from 60.1 to 56.1 with both of these changes, again, being statistically significant.

The data came from 251 children and young people aged 1–18 years (average 12.3 years) recruited from eight pediatric diabetes centers between August 2021 and December 2022 and included in the National Health Service England real-world hybrid closed-loop observational study.

The majority (89%) of the cohort was of White ethnicity, 58% were male, and the average diabetes duration was 6.6 years. The closed-loop systems used were the Tandem Control-IQ, the Medtronic MiniMed 780G, and the CamAPS FX in 78%, 11%, and 11% of participants, respectively.

Baseline glycated hemoglobin (HbA1c) averaged 62 mmol/mol (7.8%) and this decreased significantly to 54 mmol/mol (7.1%) in the 239 participants still in the study at 3 months and 55 mmol/mol (7.2%) in the 226 with 6 months of follow-up.

Likewise, time in range (TIR) rose from 49% at baseline to 64% and 63% at 3 and 6 months, respectively, and the percentage of time in hypoglycemia decreased from an average of 3.7% to 2.4% at both 3 and 6 months, report Sze May Ng (University of Liverpool) and colleagues in Diabetic Medicine.

“In this study TIR increased close to the target of 70%,” they note, but stress that even a TIR of 50% in a young person “who was struggling to bolus would represent a marked improvement.”

Baseline HbA1c was related to change over time, such that study participants with higher HbA1c had a larger reduction over the following 6 months. In line with this, those with baseline HbA1c higher than 48 mmol/mol (6.5%) had a significant increase in TIR, whereas those with lower HbA1c at baseline achieved only a nonsignificant rise.

These findings suggest that hybrid closed-loop insulin delivery may be particularly helpful in children and young people with higher HbA1c “who may be struggling with their diabetes,” the team concludes.

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2022 Springer Healthcare Ltd, part of the Springer Nature Group

Diabet Med 2022; doi:10.1111/dme.15015