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Does early closed-loop therapy preserve pancreas function in youth with type 1 diabetes?
UK: Intensive glucose control for 24 months in adolescents with new-onset type 1 diabetes did not avert the decline in endogenous insulin secretion, researchers state in a study published in the New England Journal of Medicine.
The researchers reported that youth who started on a hybrid closed-loop system within 21 days of diagnosis versus standard insulin therapy did not have less decline in residual C-peptide secretion (mean adjusted difference -0.06 pmol/mL) at 12 months.
Roman Hovorka, Wellcome–Medical Research Council Institute of Metabolic Science, Addenbrooke's Hospital, United Kingdom, and colleagues sought to clarify whether improved glucose control with hybrid closed-loop therapy can help to preserve C-peptide secretion compared to standard insulin therapy in people with new-onset type 1 diabetes in a multicenter, open-label, parallel-group, randomized trial.
Youths (n=97) aged 10.0 to 16.9 years of age (mean age, 12 years) were assigned within 21 days after type 1 diagnosis to receive hybrid closed-loop therapy (n=51) or standard insulin therapy (control; n=46) for 24 months. The analysis was done on an intention-to-treat basis. The study's primary endpoint was the curve (AUC) for the plasma C-peptide level (after a mixed-meal tolerance test) 12 months after diagnosis.
The study yielded the following findings:
- There was no notable difference between the two groups in the AUC for the C-peptide level at 12 months (primary endpoint) (geometric mean, 0.35 pmol per milliliter with closed-loop therapy and 0.46 pmol per milliliter with control therapy; mean adjusted difference, −0.06 pmol per milliliter).
- There was no substantial between-group difference in the AUC for the C-peptide level at 24 months (geometric mean, 0.18 pmol per milliliter with closed-loop therapy and 0.24 pmol per milliliter with control therapy; mean adjusted difference, −0.04 pmol per milliliter).
- The arithmetic means glycated hemoglobin level was lower in the closed-loop group than in the control group by four mmol per mole (0.4 percentage points) at 12 months and by 11 mmol per mole (1.0 percentage points) at 24 months.
- Five cases of severe hypoglycemia occurred in the closed-loop group (in 3 participants), and one occurred in the control group; one case of diabetic ketoacidosis occurred in the closed-loop group.
In an accompanying editorial, Jan Bolinder, the Karolinska Institute in Stockholm, commented, "Currently, hybrid closed-loop therapy is the most efficient option for treating type 1 diabetes, so is it not surprising that superior glucose control was achieved in the closed-loop group."
He further added, "despite this benefit, users of the closed loop system still weren't able to achieve the recommended HbA1c target of 6.5% or below, instead hovering at 6.9% after 12 and 24 months."
According to him, although the trial findings are "somewhat disappointing," it was good that closed-loop therapy aided in long-term glucose control after being introduced close to the time of diagnosis.
"Intensive glucose control for 24 months did not appear to prevent the decline in residual C-peptide secretion in youths with new-onset type 1 diabetes," the study authors concluded.
Reference:
Boughton CK, et al. "Closed-loop therapy and preservation of C-peptide secretion in type 1 diabetes" N Engl J Med 2022; DOI: 10.1056/NEJMoa2203496.
MSc. Biotechnology
Medha Baranwal joined Medical Dialogues as an Editor in 2018 for Speciality Medical Dialogues. She covers several medical specialties including Cardiac Sciences, Dentistry, Diabetes and Endo, Diagnostics, ENT, Gastroenterology, Neurosciences, and Radiology. She has completed her Bachelors in Biomedical Sciences from DU and then pursued Masters in Biotechnology from Amity University. She has a working experience of 5 years in the field of medical research writing, scientific writing, content writing, and content management. She can be contacted at  editorial@medicaldialogues.in. Contact no. 011-43720751
Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751