Automated insulin delivery improves TIR in hospitalized type 1 diabetes patients without increasing hypoglycemia

Ana María Gómez Medina and colleagues sought to describe the performance of hybrid closed-loop (HCL) and advanced hybrid closed-loop (AHCL) in the hospital setting based on the continuous glucose monitoring (CGM) metrics description. They revealed that HCL/AHCL systems with active AM/SG in T1D patients in the hospital environment lead to %TIR>70% in ranges of 70–180 mg/dL in patients without an increased hypoglycemia incidence.

The researchers note minimal evidence of the use of hybrid closed-loop/advanced hybrid closed-loop systems for inpatient management. Current guidelines do not include specific recommendations regarding HCL/AHCL systems in the hospital.

The investigators conducted an observational study from a cohort of patients with type 1 diabetes using HCL/AHCL with a history of hospitalization. During the hospital stay, CGM metrics were analyzed. They also performed a CGM metrics sub-analysis of the population with active Automated Mode and SmartGuard during hospitalization and/or surgical procedures. Twenty-four patients were included (50% women; mean age, 49 years).

The researchers reported the following findings:

• During hospitalization, 70.8% of patients achieved a time in Range (TIR) between 70–180 mg/dL≥70%.
• The overall %TIR was 75.5%, the % time below range (TBR)<70 mg/dL was 2.1% and the %TBR<54 mg/dL was 0%.
• Users of the AHCL with active SG achieved a non-significant higher %TIR during hospitalization (79% versus 76%) and had a shorter stay (3 versus 6 days) compared to the users of the HCL with AM active.
• No device-related serious adverse events occurred for users of either system.

Noting a little evidence about using HCL and AHCL systems in a hospital setting, the researchers add that the study shows that the use of this technology in type 1 diabetes patients in a real-life hospital environment maintained the %TIR between 70 and 180 mg/dL without increasing hypoglycemia both in the general ward and during surgical procedures.

Additionally, AHCL use with active SG was linked with a higher %TIR without increasing hypoglycemia and a shorter hospital stay compared to the use of HCL with active AM.

"However, there is a need for further studies to determine whether the use of this technology can impact outcomes such as hospital stay, mortality, and morbidity among hospitalized patients," they concluded.

Reference:

María Gómez Medina A, Cristina Henao-Carrillo D, Yepes C, Silva J, Alberto Gómez González J, Cortes D, Robledo S, Mejía G, Rondon M. Glycemic control metrics in a cohort of hospitalized patients with type 1 diabetes using hybrid closed-loop and advanced hybrid closed-loop systems. Diabetes Res Clin Pract. 2023 Sep 5:110897. doi: 10.1016/j.diabres.2023.110897. Epub ahead of print. PMID: 37678728.