REAL-WORLD IMPLICATIONS OF HYBRID CLOSE LOOP (HCL) INSULIN DELIVERY SYSTEM
Objective: Clinical trial data demonstrates improved glycemic control with hybrid close loop (HCL) insulin delivery systems, yet limited real-world data exists. Data from the inaugural cohort of patients initiating a HCL system (Medtronic MiniMed™ 670G, Medtronic Canada, Brampton, ON) at a university medical center was used to examine real-world utilization and glycemic control following a standardized implementation process. Methods: Data from 34 adult patients with type 1 diabetes were obtained from pump downloads at 4 time points: (1) previous insulin pump, (2) HCL in manual-mode, (3) 2 weeks after HCL auto-mode transition, and (4) 6 to 12 weeks after initiation of HCL. In-person training by certified diabetes educators was performed across 3 sessions with phone and electronic messaging following auto-mode start. Results: Mean self-monitored blood glucose (SMBG) per day increased from 5.15 baseline to 6.49 at 6 to 12 weeks (P<.05) with 3.26 sensor calibrations per day. Time-in-auto-mode was 79.3% at 2 weeks and 72.3% at final follow-up, with 82% of patients spending >50% of time in auto-mode. There were 8.2 auto-mode exits over the final 14-day download. Time-in-target was 67.3% in manual-mode, 73.4% at 2 weeks (P = .09), and 71.7% by 6 to 12 weeks (P = .06). Hemoglobin A1c (HbA1c) decreased by 0.51% (P = .02), while total daily dose and % basal did not change. Patients with HbA1c <7.0% (53 mmol/mol) at baseline spent more time-in-target than those with HbA1c ≥7.0% (53 mmol/mol; 78.0% versus 67.5%) despite spending less time-in-auto-mode (66.5% versus 74.8%). Conclusion: These data illustrate real-world implementation of HCL technology using a structured education program within a major medical center. Overall benefit may vary based on baseline characteristics such as HbA1c. Abbreviations: CDE = certified diabetes educator; HbA1c = hemoglobin A1c; HCL = hybrid closed loop; SMBG = self-monitored blood glucose.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2019 |
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| Erschienen: |
2019 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:25 |
|---|---|
| Enthalten in: |
Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists - 25(2019), 5 vom: 01. Mai, Seite 477-484 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Faulds, Eileen R [VerfasserIn] |
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| Links: |
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| Themen: |
Blood Glucose |
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| Anmerkungen: |
Date Completed 11.06.2019 Date Revised 07.12.2022 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.4158/EP-2018-0515 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM294887237 |
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| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Objective: Clinical trial data demonstrates improved glycemic control with hybrid close loop (HCL) insulin delivery systems, yet limited real-world data exists. Data from the inaugural cohort of patients initiating a HCL system (Medtronic MiniMed™ 670G, Medtronic Canada, Brampton, ON) at a university medical center was used to examine real-world utilization and glycemic control following a standardized implementation process. Methods: Data from 34 adult patients with type 1 diabetes were obtained from pump downloads at 4 time points: (1) previous insulin pump, (2) HCL in manual-mode, (3) 2 weeks after HCL auto-mode transition, and (4) 6 to 12 weeks after initiation of HCL. In-person training by certified diabetes educators was performed across 3 sessions with phone and electronic messaging following auto-mode start. Results: Mean self-monitored blood glucose (SMBG) per day increased from 5.15 baseline to 6.49 at 6 to 12 weeks (P<.05) with 3.26 sensor calibrations per day. Time-in-auto-mode was 79.3% at 2 weeks and 72.3% at final follow-up, with 82% of patients spending >50% of time in auto-mode. There were 8.2 auto-mode exits over the final 14-day download. Time-in-target was 67.3% in manual-mode, 73.4% at 2 weeks (P = .09), and 71.7% by 6 to 12 weeks (P = .06). Hemoglobin A1c (HbA1c) decreased by 0.51% (P = .02), while total daily dose and % basal did not change. Patients with HbA1c <7.0% (53 mmol/mol) at baseline spent more time-in-target than those with HbA1c ≥7.0% (53 mmol/mol; 78.0% versus 67.5%) despite spending less time-in-auto-mode (66.5% versus 74.8%). Conclusion: These data illustrate real-world implementation of HCL technology using a structured education program within a major medical center. Overall benefit may vary based on baseline characteristics such as HbA1c. Abbreviations: CDE = certified diabetes educator; HbA1c = hemoglobin A1c; HCL = hybrid closed loop; SMBG = self-monitored blood glucose | ||
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| 700 | 1 | |a Zappe, Janet |e verfasserin |4 aut | |
| 700 | 1 | |a Dungan, Kathleen M |e verfasserin |4 aut | |
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