The advanced hybrid closed-loop (AHCL) system can significantly improve glycemic control in children and adolescents with type 1 diabetes, according to a new study published in Journal of Diabetes Science and Technology. The prospective, open-label, single-arm study analyzed data from 50 children and adolescents with type 1 diabetes who switched from sensor-augmented pumps with low-glucose suspend (SAP-LGS) or predictive low-glucose suspend (SAP-PLGS) to the AHCL system (MiniMed 780G Medtronic). The findings indicate notable improvements in glycemic control, particularly during nighttime, without increasing the risk of hypoglycemia.
Key Glycemic Improvements
Researchers compared glycemic data from the two weeks preceding AHCL use with the first four weeks of AHCL use. Results showed significant improvements in several key parameters within the first two weeks of switching to the AHCL system:
- Time in Range (TIR): Increased time spent in the range of 70-140 mg/dL (from 53.80% to 61.70%, P < 0.001) and 70-180 mg/dL (from 76.17% to 81.32%, P < 0.001).
- Average Sensor Glucose (Avg SG): Decreased from 138.61 mg/dL to 130.02 mg/dL (P < 0.001).
- Glucose Management Indicator (GMI): Improved from 6.54% to 6.27% (P = 0.001).
Notably, the improvements were more pronounced during nighttime monitoring.
Study Design and Patient Population
The study included children and adolescents aged 5.5 to 19.6 years with type 1 diabetes. All participants had been using SAP-LGS/PLGS systems for at least six months prior to switching to the Medtronic MiniMed 780G system. The AHCL system was set to a target glucose level of 100 mg/dL for all patients, with autocorrect activated and active insulin time set at 2 hours. Patients and caregivers were instructed to use a temporary target of 150 mg/dL during physical activity.
Clinical Implications
The findings suggest that the AHCL system can offer significant benefits even for well-controlled children and adolescents with type 1 diabetes. "The AHCL system can significantly improve glycemic control even in well-controlled children and adolescents with type 1 diabetes by increasing the proportion of time spent in the narrower range of 70–140 mg/dL and decreasing the mean glucose concentration, especially during the night," the authors concluded. These improvements were achieved without jeopardizing treatment safety, as indicated by the lack of significant changes in time spent in hypoglycemia and total daily insulin dose.
Comparison with Previous Studies
While previous studies have examined the effectiveness of AHCL systems in patients with type 1 diabetes, many included heterogeneous age groups, with children and adolescents representing only a fraction of the participants. This study focused specifically on a homogenous cohort of young patients already experienced in using SAP-LGS/PLGS systems, providing valuable insights into the benefits of AHCL technology in this population.
Limitations
The authors acknowledge several limitations, including the relatively short observation time (4 weeks), the lack of glycated hemoglobin measurements, and the absence of a control arm. However, they note that the most beneficial effects were observed within the first 14 days of switching to the new system, with subsequent stabilization during the following two weeks. The study was conducted at a single center and was open-label in design.
Future Directions
Despite these limitations, the study provides compelling evidence for the effectiveness of AHCL systems in improving glycemic control in children and adolescents with type 1 diabetes. Further research with longer follow-up periods and controlled study designs is warranted to confirm these findings and explore the long-term benefits of AHCL technology in this population.
