Endocrine Abstracts

Background: Hybrid closed loop (HCL) insulin pump systems have demonstrated improvements in glycaemic control, time in range (TIR), frequency of hypoglycaemia and quality of sleep for children and young people when using HCL for 6 months². NICE recommends considering HCL for children with type 1 diabetes¹. However, initiating HCL therapy in high-risk patients, particularly those with poor glycaemic control and inconsistent adherence to treatment, raises concerns about the potential for diabetic ketoacidosis (DKA). To mitigate this risk, we incorporated ultralong-acting insulin (Insulin Degludec) during the transition phase to HCL therapy.

Aim: To assess the impact of combining ultralong-acting insulin with HCL insulin pump therapy on glycaemic outcomes, body mass index (BMI), and quality of life in high-risk individuals with type 1 diabetes.

Methods: Patients with persistently elevated HbA1c and suspected disguised non-compliance were initiated on HCL insulin pump therapy. As a safety measure, 30% of their basal insulin requirement was provided as insulin Degludec (Tresiba) to reduce the risk of DKA during the transition. Initial glucose targets were conservatively set at 8.3 mmol/l to avoid rapid glycaemic shifts and potential retinopathy. Outcomes assessed included changes in HbA1c, TIR, time above range (TAR), Body mass index (BMI), and patient-reported quality of life.

Results: Five patients were initiated on this combined regimen. Four of them continued HCL therapy successfully. Their Mean HbA1c decreased from 92.25 pre- HCL pump start to 67 mmol/mol on HCL, with the mean TIR improving from 19.5% to 53.75%. The mean TAR, particularly time spent in the very high blood glucose range, significantly reduced. No episodes of DKA or clinically significant hypoglycaemia were reported. All participants noted improved quality of life and engaged better with diabetes care. BMI trends showed improvement in the underweight patients and maintenance or reduction of BMI in the children who were overweight.

Conclusion: The adjunctive use of ultralong-acting insulin during HCL pump initiation appears to be a safe and effective strategy for high-risk patients. It supports improved glycaemic control, enhances patient engagement and seems to reduce the risk of acute complications without compromising safety.