Switching to an advanced hybrid closed-loop system in real-world practice improves hypoglycemia awareness and metabolic control in adults with type 1 diabetes, particularly in those with impaired perception of hypoglycemia symptoms
Authors' conclusion
Switching from any type of insulin administration to AHCL system improves restoration of hypoglycemia awareness and metabolic control in patients with T1D, particularly in adults with impaired perception of hypoglycemia symptoms.
Study context
- Population
- Adults with T1D using flash glucose monitoring (FGM) or continuous glucose monitoring (CGM) switching to Minimed 780G; mean age 37 ± 15, diabetes duration 20 ± 10 years
- Participants
- 46 adults
- Exposure
- Before vs after switching to Minimed 780G AHCL system
- Multiple dose insulin (MDI) + FGMn = 6
- CSII + FGMn = 21
- Sensor-augmented pump with predictive low-glucose suspendn = 19
- Outcome
- Restoration of hypoglycemia awareness (Clarke's score; IAH defined as Clarke's score ≥ 3)
- Follow-up
- 6 months
Methodological detailsreal-world, single-arm switch to AHCL
- Real-world
- Single-arm switch to AHCL
Main finding
As reported in the abstract
Impaired awareness of hypoglycemia (IAH) at baseline
12 patients
27%
IAH after 6 months on AHCL
3 patients
7%
Absolute risk reduction of having IAH
20%
95% CI 7–32
Clarke's score in patients with IAH, baseline to 6 months
3.6 ± 0.8 to 1.9 ± 1.6
P < 0.001
Observational data: associations, not effects.
Further findings
A1c, overall · baseline to 6 months
- A1c decreased regardless of prior insulin therapy
- from 6.9 ± 0.5% to 6.7 ± 0.6%, P < 0.001
A1c by hypoglycemia awareness · baseline to 6 months
- Greater A1c improvement with IAH vs without IAH
- 6.9 ± 0.5 to 6.4 ± 0.4% vs 6.9 ± 0.5 to 6.8 ± 0.6% (P = 0.003)
- Parallel increase in total daily boluses and automatic bolus correction
Baseline characteristics by IAH
- Patients with IAH were older and had lower estimated glomerular filtration rate (eGFR); no differences in baseline CGM metrics or A1c
Original publication
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