Predictors of Time-in-Range (70-180 mg/dL) Achieved Using a Closed-Loop Control System

Area of Science:

• Endocrinology
• Pediatric Diabetes Management
• Biomedical Engineering

Background:

• Closed-loop control (CLC) systems significantly improve glycemic control in type 1 diabetes (T1D), measured by increased time-in-range (TIR).
• Predictors of TIR in CLC users are needed to optimize therapy, particularly in pediatric populations.

Purpose of the Study:

• To identify clinical predictors of TIR in children with T1D using a CLC system.
• To evaluate the relationship between baseline glycemic control and TIR achieved with CLC therapy.

Main Methods:

• Analysis of data from 100 children (aged 6-13) with T1D using the Tandem Control-IQ CLC system.
• Continuous glucose monitoring data collected at baseline and during 12-16 weeks of CLC use.
• Stratification into TIR quartiles to compare clinical characteristics and treatment parameters.

Main Results:

• Higher baseline TIR was the strongest predictor of TIR on CLC (r=0.69).
• Lower baseline TIR was associated with the greatest improvement in TIR on CLC (r=-0.81).
• Higher TIR quartiles showed more user-initiated boluses and fewer automated boluses compared to lower quartiles.

Conclusions:

• Baseline TIR is a key predictor of CLC effectiveness in pediatric T1D.
• Patients with lower baseline TIR experience the most significant improvements with CLC.
• User engagement remains crucial for optimizing glycemic control with CLC systems.