Endocrine Abstracts

Background: NICE Technology appraisal guidance (TA 943) published December 2023 recommended Hybrid-closed loop (HCL) pumps as treatment options for all Children and Young People (CYP) with Type 1 Diabetes. The NHSE outlined an implementation strategy highlighting children and young people (CYP) as a target group to roll-out this therapy. We sought to evaluate the delivery of HCL systems over 1-year period to CYP in our paediatric diabetes unit (PDU)

Methods: We conducted a retrospective study looking at CYP commenced on HCL pumps between 01/10/2023 – 30/09/2024. Health outcomes analysed include median HbA1c and average glucose time in range (TIR). Data was also collected on patient ages, deprivation status (IMD1-5, 1 – most deprived, 5 – least deprived).

Results: 45 patients were identified during this period. 7 patients excluded due to leaving or transfer of care to young adult team following transition. 38 patients were included and belonged to age 3-18 years. The median age was 14 years. 11 patients (29%) were from IMD-1 most deprived group. 76.3% (29 patients) showed improvement in HbA1c post-HCL start, 21.1% (8 patients) showed no change or worsening HbA1c and 2.6% (1 patient) maintained good HbA1c. Proportion of CYP achieving NICE HbA1c target 48 mmol/mol increased from 7.9% to 23.7% post-HCL (P <.031). Those with HbA1c 80 mmol/mol or higher reduced 18.4% to 2.6% post-HCL. Median HbA1c decreased 61 mmol/mol to 54 mmol/mol (P <.001). Median glucose TIR increased from 51% to 65%, (1 patient excluded due to lack of pre-HCL TIR data). 8 CYP had no change or worsening in HbA1c and of them 4 (50%) were from most deprived quintile IMD-1 and 4(50%) were 16-18 age group.

Discussion: Most of the CYP improved their HbA1c and increased time in range following HCL therapy, with median HbA1c decreasing significantly. More CYP achieved NICE treatment target. Half of the patients showing no improvement were from most deprived quintile and were in 16-18 yrs age. CYP in transition and most deprived requires close monitoring despite advanced treatment technology. Limitations in our study is small sample size. Further research is needed to understand deprivation and age influencing outcomes in CYP on HCL technology.