Endocrine Abstracts

JOINT719

Introduction: Type 1 diabetes (T1D) incidence is increasing in very young children (i. e. under 6 years of age). Achievement of glycaemic targets in this subgroup is challenging due to their variable insulin needs, unpredictable eating habits, and activity levels. This leads to poor metabolic control and increased diabetes-related complications. Hybrid closed-loop (HCL) systems offer promising solutions to improve glycaemic outcomes. However, studies in very young children are scarce and show inconsistent results in reducing hypoglycemia and glycaemic variability. The aim of this study was to evaluate the impact of HCL on glycaemic control and more specifically the patterns of glycemic parameters throughout the day.

Materials and Methods: Data were collected from fifty children with T1D for ≥6 months who switched to HCL (CAM APS FX) before 6 years of age in two pediatric diabetes centre. Clinical and continuous glucose monitoring (CGM) data were collected before (Pre-HCL) and at 1, 3, and 6 months post-HCL initiation. From the raw CGM data, metrics of hyperglycemia, hypoglycemia, euglycemia and glucose variability (global, intra-day and inter-day) were calculated. Comparisons between Pre-HCL and every post-HCL periods were performed using student t-tests.

Results: Time in range (TIR, 70-180mg/dL) significantly increased of 11. 9% ± 11% from 1 month after HCL (P < 0. 001) with a concomitant decrease of target above range (TAR, >180 mg/dL) of -13% ± 13. 4% (P < 0. 01). The improvement in glycemic control was sustained at 6 months with greatest differences observed during the night (P < 0. 001). Hypoglycaemic episodes (<70mg/dL and <54mg/dL) remained similar before and after HCL (all p>0. 05). However, hourly glycaemic patterns sustain that the morning period (7AM-1PM) was at significantly higher risk for hypoglycemia after HCL initiation with time below range (<70mg/dL) and LBGI peaking at respectively 6. 6% ± 7. 5% and 1. 5±1. 5 at 1 month compared to 1PM-7AM period (P < 0. 0001). This risk of hypoglycaemia persisted for up to 6 months (P < 0. 01). Finally, while the coefficient of variation remained stable at all time points (p>0. 05), a significant decrease in intra-day (MAGE) and inter-day glucose variability (CONGA, MODD) was observed from 1 month post-HCL (all P < 0. 05).

Conclusion: In real life, HCL significantly improved the TIR and TAR in very young children with T1D from the first month after activation of the system. Morning time demonstrated to be a period at risk of hypoglycaemia in this age group, highlighting the importance of optimizing HCL therapy and informing parents of these specific times at risk of glycaemic instability.