Endocrine Abstracts

JOINT1477

Introduction: Hybrid closed-loop (HCL) systems consist of three essential components: a continuous glucose monitoring (CGM) sensor, an algorithm that analyzes data from the CGM, and an insulin pump capable of delivering varying doses of insulin based on this information, alongside doses administered by the user. These technologies aim to improve metabolic control and reduce hypoglycemia risk, enhancing patients’ quality of life.

Material and methods: We conducted a retrospective study involving children with type 1 diabetes (T1D) who were admitted to our department to initiate HCL insulin pump therapy. We evaluated the patients at two key points: at baseline, when the insulin pump was first initiated, and during a follow-up visit at least six months later. We assessed glycated hemoglobin (HbA1c) levels at both time points and downloaded CGM reports documenting the previous 90 days. These reports included various parameters: time in range (TIR: 70-180 mg/dL), time in tight range (TITR: 70-140 mg/dL), time below range (TBR) categorized as <70 mg/dL, 54-70 mg/dL, and <54 mg/dL, time above range (TAR) categorized as >180 mg/dL, 180-250 mg/dL, and >250 mg/dL, and the coefficient of variation (CV). This research aimed to assess the effectiveness of HCL therapy in improving glycemic control in children with T1D.

Results: Thirty-two children (68.8% female) participated in the study. Participants had an average age of 11.5 years (±2.8) and a mean diabetes duration of 5.8 years (±3.7), with an average follow-up time of 11.9 months (±4). At follow-up, HbA1c decreased significantly (7±1% vs 6.6±0.6%, P = 0.01). CGM reports were available at baseline and follow-up for 27 patients. The results revealed a significant increase in TIR (69.2±15.7% to 79.4±7.9%, P<0.001). Additionally, TITR rose from 48.4±16.9% to 57.9±10.1% (P<0.001). TBR <70 mg/dL and between 54-70 mg/dL significantly decreased: TBR <70 decreased from 5.4±3.6% to 3.2±2.3% (P = 0.008), and TBR 54-70 decreased from 4.2±2.2% to 2.7±1.9% (P = 0.007). TBR <54 mg/dL decreased also, but this change was not statistically significant (1.2% vs. 0.5%, P = 0.06). Furthermore, TAR and its subintervals showed significant reductions: TAR >180 mg/dL dropped from 25.3±16.2% to 17.2±8.1% (P = 0.02), TAR 180-250 mg/dL decreased from 18.1±9.3% to 13.8±5% (P = 0.003), and TAR >250 mg/dL fell from 7.2% to 3.3% (P = 0.006). The CV also significantly decreased, changing from 37.4±7.3% to 34.3±5.3% (P<0.001).

Conclusions: HCL systems enhance metabolic control in children with T1D, helping them achieve targets for glucose variability and increasing time spent in normoglycemia, thus reducing the risk of short-term and long-term complications.