Chinenye O Usoh1, Crystal Paige Johnson1, Jaime L Speiser2, Richa Bundy3, Ajay Dharod4, Joseph A Aloi1. 1. Division of Endocrinology, Diabetes and Metabolism, Wake Forest University School of Medicine, NC, USA. 2. Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, NC, USA. 3. Department of Internal Medicine, Wake Forest University School of Medicine, NC, USA. 4. Wake Forest Department of Implementation Science, Wake Forest Center for Healthcare Innovation, Wake Forest Center for Biomedical Informatics, Wake Forest University School of Medicine, Department of Internal Medicine, NC, USA.
Abstract
BACKGROUND: Hybrid closed-loop (HCL) insulin pump therapy (Medtronic 670G) is an emerging technology that is growing in use worldwide. Initial clinical trials demonstrated the effectiveness of HCL in reducing hypoglycemia and improving glucose control; however, these subjects were intensely monitored and supervised. There has been concern regarding the ability of patients to remain in auto mode. We aimed to assess HCL when used in a typical outpatient endocrine clinic. METHODS: We initially analyzed data from 80 individuals with type 1 diabetes managed in an endocrine clinic by a single certified diabetes educator (CDE). We then included our other providers and had 230 subjects by the end of the study. Patients were either transitioned from traditional insulin pump or multiple daily insulin injection therapy (MDI) to HCL. Patients initiated to HCL pump therapy from July 2017 through February 2020 were studied. Endpoints of change in time in hypoglycemic/hyperglycemic range and time in target range were analyzed. The primary outcome was a change in percent time in the target range during manual mode compared with auto mode. RESULTS: There was an 18.2% increase in average time in target range when comparing manual mode to auto mode (59.3% vs 70.1%, P < .0001). Average time in hyperglycemic range was significantly reduced by 26.7% (39.0% vs 28.6%, P < .0001) but without increasing average time in hypoglycemic range (1.7% vs 1.3%, P = 0.95). CONCLUSIONS: HCL was effective in reducing hyperglycemia and increasing time in the target range but did not increase hypoglycemia. These data suggest HCL will improve the metrics of glucose control.
BACKGROUND: Hybrid closed-loop (HCL) insulin pump therapy (Medtronic 670G) is an emerging technology that is growing in use worldwide. Initial clinical trials demonstrated the effectiveness of HCL in reducing hypoglycemia and improving glucose control; however, these subjects were intensely monitored and supervised. There has been concern regarding the ability of patients to remain in auto mode. We aimed to assess HCL when used in a typical outpatient endocrine clinic. METHODS: We initially analyzed data from 80 individuals with type 1 diabetes managed in an endocrine clinic by a single certified diabetes educator (CDE). We then included our other providers and had 230 subjects by the end of the study. Patients were either transitioned from traditional insulin pump or multiple daily insulin injection therapy (MDI) to HCL. Patients initiated to HCL pump therapy from July 2017 through February 2020 were studied. Endpoints of change in time in hypoglycemic/hyperglycemic range and time in target range were analyzed. The primary outcome was a change in percent time in the target range during manual mode compared with auto mode. RESULTS: There was an 18.2% increase in average time in target range when comparing manual mode to auto mode (59.3% vs 70.1%, P < .0001). Average time in hyperglycemic range was significantly reduced by 26.7% (39.0% vs 28.6%, P < .0001) but without increasing average time in hypoglycemic range (1.7% vs 1.3%, P = 0.95). CONCLUSIONS: HCL was effective in reducing hyperglycemia and increasing time in the target range but did not increase hypoglycemia. These data suggest HCL will improve the metrics of glucose control.
Entities:
Keywords:
Medtronic 670G; auto mode; hybrid-closed loop insulin pump
Authors: Richard M Bergenstal; Satish Garg; Stuart A Weinzimer; Bruce A Buckingham; Bruce W Bode; William V Tamborlane; Francine R Kaufman Journal: JAMA Date: 2016-10-04 Impact factor: 56.272
Authors: A Nicolucci; A Maione; M Franciosi; R Amoretti; E Busetto; F Capani; D Bruttomesso; P Di Bartolo; A Girelli; F Leonetti; L Morviducci; P Ponzi; E Vitacolonna Journal: Diabet Med Date: 2008-01-14 Impact factor: 4.359
Authors: Satish K Garg; Stuart A Weinzimer; William V Tamborlane; Bruce A Buckingham; Bruce W Bode; Timothy S Bailey; Ronald L Brazg; Jacob Ilany; Robert H Slover; Stacey M Anderson; Richard M Bergenstal; Benyamin Grosman; Anirban Roy; Toni L Cordero; John Shin; Scott W Lee; Francine R Kaufman Journal: Diabetes Technol Ther Date: 2017-01-30 Impact factor: 6.118
Authors: Martin Tauschmann; Hood Thabit; Lia Bally; Janet M Allen; Sara Hartnell; Malgorzata E Wilinska; Yue Ruan; Judy Sibayan; Craig Kollman; Peiyao Cheng; Roy W Beck; Carlo L Acerini; Mark L Evans; David B Dunger; Daniela Elleri; Fiona Campbell; Richard M Bergenstal; Amy Criego; Viral N Shah; Lalantha Leelarathna; Roman Hovorka Journal: Lancet Date: 2018-10-03 Impact factor: 202.731
Authors: Rayhan A Lal; Marina Basina; David M Maahs; Korey Hood; Bruce Buckingham; Darrell M Wilson Journal: Diabetes Care Date: 2019-09-23 Impact factor: 19.112