Automated insulin delivery improves TIR in hospitalized type 1 diabetes patients without increasing hypoglycemia
Carrera: HCL/AHCL systems with the Automated Mode/SmartGuard feature in patients with type 1 diabetes (T1D) in the hospital environment lead to improved time in range without increasing hypoglycemia, a recent study published in Diabetes Research and Clinical Practice has revealed.
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.
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