Switching to advanced hybrid closed-loop system improves detection of hypoglycemia in T1D patients

There is a lack of data regarding AHCL system efficacy in improving A1c among patients with an appropriate perception of symptoms of hypoglycemia than those presenting with IAH( impaired awareness of hypoglycemia).

This was determined by a team of researchers conducting a prospective study on 46 subjects.

They classified the Patients into three groups based on therapy used before switching to Minimed® 780G.

• Multiple dose insulin (MDI) therapy + FGM, including six patients.
• Continuous subcutaneous insulin infusion + FGM in 21 patients
• Sensor-augmented pump with predictive low-glucose suspend in 19 patients.

The study results could be summarised as follows:

• The mean age of participants was 37 ± 15 years, with a diabetes duration of 20 ± 10 years.
• Twelve patients constituting 27%, showed IAH as defined by Clarke’s score ≥ 3 at baseline.
• IAH patients were older with lower estimated glomerular filtration rate (eGFR) than those without IAH having no baseline differences in CGM metrics or A1c.
• After six months, there was an overall decrease in A1c in the AHCL system from 6.9 ± 0.5% to 6.7 ± 0.6%, regardless of prior insulin therapy.
• IAH patients showed more significant improvement in metabolic control with a reduction in A1c from 6.9 ± 0.5 to 6.4 ± 0.4% vs 6.9 ± 0.5 to 6.8 ± 0.6%. A parallel increase in total daily insulin boluses and automatic bolus correction administered by the Advanced Hybrid Closed Loop system.
• After six months, patients with IAH Clarke’s score decreased from 3.6 ± 0.8 (baseline) to 1.9 ± 1.6
• After six months on the AHCL system, three patients constituting 7%, presented with Clarke’s score ≥ 3 and had an absolute risk reduction of 20% of having IAH.

They wrote, “Switching from any insulin administration to an advanced hybrid closed-loop system improves hypoglycemia awareness and metabolic control in patients with a history of type 1 diabetes, particularly in adults with the impaired perception of hypoglycemia symptoms.

Further reading:

Lía Nattero-Chávez et al., 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 the impaired perception of hypoglycemia symptoms. https://doi.org/10.1016/j.diabres.2023.110627