medwireNews: Researchers find that the type of benefits people with type 1 diabetes gain from hybrid closed-loop insulin delivery differs according to their baseline glycemic control.
Fourteen of the 168 participants of the International Diabetes Closed-Loop (iDCL) trial had tightly controlled glucose levels (glycated hemoglobin [HbA1c] <6.5%, 48 mmol/mol). For these individuals, the main benefit of closed-loop delivery came at night, when automated adjustment of the basal insulin rate resulted in a 6.8% reduction in nocturnal hypoglycemia.
At the other end of the range, the 14 people with baseline HbA1c of 8.5% or higher had the largest reductions in time spent in hyperglycemia (>180 mg/dL, 10 mmol/L), by 19.2% during the day and 30.4% overnight. This was partly due to the system administering a high number of automated correction boluses; this group received a median of 5.7 per day, whereas those with tight glucose control received a median of just 1.9 in a day.
The high number in the group with HbA1c over 8.5% is “in apparent compensation for missed meal boluses,” write Laya Ekhlaspour (Stanford University School of Medicine, California, USA) and study co-authors in Diabetes Technology & Therapeutics.
The researchers say that many closed-loop studies excluded people with very tightly or poorly controlled glucose levels, but say that their findings “are a strong argument for not having restrictions on who should have access to this technology.”
They stress: “Potential users should not be excluded because they have already achieved recommended HbA1c targets, or because they have high HbA1c levels.”
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