Search Results (4)

The development of closed-loop systems represents an evolutionary advance in the management of patients with type 1 diabetes (T1D). This study aimed to analyze the impact of the Control-IQ advanced hybrid closed-loop (AHCL) system on glucometric outcomes in a pediatric and adolescent population with T1D, comparing results with baseline values and assessing the influence of baseline Time in Range (TIR) on glycemic control in children under 6 years old over a 12-month period. A 12-month prospective analysis was conducted in 26 patients with T1D (aged 2–15 years) initiating the Control-IQ system. Glucometric variables were assessed at baseline (before system implementation) and at 1, 3, 6, and 12 months post-implementation. A subgroup analysis was performed in patients under 6 years old (n = 13), to evaluate the relationship between basal TIR and glucometric outcomes during the follow-up. TIR increased significantly from 62.04% at baseline to 72.50% at one month (from 57.58% to 66.18% in patients under 6 years), with this improvement sustained throughout follow-up. Time in hyperglycemia 180–250 mg/dL (TAR1) also showed significant improvement (26.84% to 17.40% at one month; 28.66% to 20.09% in patients under 6 years), with significant reductions maintained at all timepoints. Stratification according to the proportion of patients meeting consensus targets revealed significant improvements in TIR and TAR2 at 1 and 12 months in the overall cohort, though not in the under-6 subgroup. Significant differences in TIR and coefficient of variation (CV) were observed based on baseline TIR categorization (<70% vs. ≥70%). Our study revealed a significant enhancement in TIR and time spent in hyperglycemia from the first month after the implementation of the closed-loop system, which was maintained at 12 months, in both the overall cohort and the subgroup under 6 years old. In this younger subgroup, baseline TIR predicted subsequent glycemic control, with higher baseline TIR associated with better long-term outcomes in both TIR and CV. Full article

Background and Objectives: Automated insulin delivery (AID) systems represent a major advancement in type 1 diabetes (T1D) management, particularly in pediatric populations. However, real-world evidence comparing their effectiveness to conventional multiple daily injection (MDI) therapy in youth remains limited. This study aimed to evaluate the impact of transitioning from MDI therapy to AID systems on glycemic control in children and adolescents with T1D, and to explore potential differences based on baseline HbA1c levels and device type. Materials and Methods: In this single-center, retrospective observational study, 76 children and adolescents with T1D were evaluated before and after switching from MDI to either the Medtronic MiniMed™ 780G or Tandem t:slim X2™ Control-IQ system. Glycemic control was assessed using continuous glucose monitoring (CGM)-derived metrics at three time points: the last 15 days of MDI therapy (T0), 15 days after (T1), and 6 months after (T2) AID initiation. Statistical comparisons were conducted across time points and between subgroups stratified by baseline HbA1c and AID system. Results: Significant improvements in glycemic control were observed as early as 15 days after AID initiation, with sustained benefits at 6 months. Time in range (TIR) increased from 62.0% at baseline to 76.7% at 15 days and 75.8% at 6 months, and time in tight range (TITR) from 39.8% to 53.9% at T1 and 52.1% at T2 (both p < 0.001). Improvements were more pronounced in participants with higher baseline HbA1c (+16.9% for TITR and +22.3% for TIR). No significant differences in glycemic outcomes were observed between device groups, although algorithm-driven differences in insulin delivery patterns were noted. Total daily insulin dose and BMI increased significantly over time (p < 0.001 and p = 0.008, respectively). Conclusions: AID therapy leads to rapid and sustained improvements in glycemic control among youth with T1D, particularly in those with suboptimal baseline control. These benefits highlight the clinical value of AID systems, while also emphasizing the need for monitoring potential metabolic impacts. Full article

Background: Advanced hybrid closed-loop (AHCL) systems have improved the glycemic control in type 1 diabetes (T1D). While time in range (TIR) (70–180 mg/dL) is the standard metric, time in tight range (TITR) (70–140 mg/dL) offers a stricter assessment. Real-world comparisons using the TITR are limited. This study compared the TIR and TITR metrics between the MiniMed™ 780G and Tandem Control-IQ™ in adults with T1D. Methods: This retrospective, single-center study included 42 propensity-score-matched adults with T1D (28 MM780G users and 14 Tandem Control-IQ users), each with ≥3 months of AHCL system use. Glycemic metrics from continuous glucose monitoring (CGM) were analyzed over a 14-day period. Comparisons between groups were conducted using Mann–Whitney U tests, adjusted linear regression, and linear mixed-effects models accounting for repeated measures. Results: At three months, the MM780G users achieved significantly higher TITR (60.1% ± 12 vs. 49.5% ± 9.3; p = 0.005) and TIR (83.7% ± 7.6 vs. 72.1% ± 7.5; p < 0.001) values, along with lower glucose variability, compared to these values in the Tandem Control-IQ users. The linear regression model confirmed that the MM780G was independently associated with a higher TITR (β = 14.2; p = 0.005). Mixed-effects modeling for the TIR showed a significant interaction between timepoint and device type (β = 4.81; p = 0.006), favoring the MM780G. Conclusions: In this real-world analysis, both AHCL systems improved glycemic control, but the MiniMed 780G could be associated with a superior performance in achieving tighter glucose targets without increasing hypoglycemia. TITR may serve as a valuable complementary metric alongside TIR in evaluating AHCL systems’ effectiveness. However, these findings should be interpreted cautiously due to limitations such as the retrospective design, small sample size, potential residual confounding, and lack of standardization in the device settings. Further studies are warranted to confirm these results and assess their generalizability. Full article

The introduction of closed-loop systems in the pediatric population has been a revolution in the management and evolution of diabetes. However, there are not many published studies in situations in which the feeding, schedules, and activities of the children deviate from the routine for which the systems were programmed, as in the case of a summer camp for children and adolescents with diabetes, where the specific programming of this device is not well known. It was a single-center prospective preliminary study. A total of twenty-seven patients (mean age 11.9 ± 1.9 years, 40% male, duration of diabetes 6.44 ± 2.83 years) were included (twenty with Medtronic MiniMed 780G system and seven with Tandem Control-IQ). Glucometric variables and pump functionality were monitored during the 7-day camp and in the following 3 weeks. There was no decrease from the objective TIR 70% at any moment. The worst results in Time Below Range were at 72 h from starting the camp, and the worst results in Time Above Range were in the first 24 h, with a progressive improvement after that. No episodes of level 3 hypoglycemia or ketoacidosis occurred. The use of specific programming in two integrated systems, with complex blood glucose regulation algorithms and not-prepared-for situations with increased levels of physical activity or abrupt changes in feeding routines, did not result in an increased risk of level 3 hypoglycemia and ketoacidosis for our pediatric type 1 diabetes (T1D) patients, regardless of the closed-loop device. Full article