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Are all HCL systems the same? long term outcomes of three HCL systems in children with type 1 diabetes: real-life

Alzbeta Santova1,2, Lukas Plachy1, Vit Neuman1

  • 1Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Prague, Czechia.

Frontiers in Endocrinology
|November 1, 2023
PubMed

Insights

The AndroidAPS hybrid closed loop system showed the lowest HbA1c in children with T1D, but also more hypoglycemia. The Medtronic 780G system offered the lowest Glycemia Risk Index, indicating better overall glycemic control.

Area of Science:

  • Pediatric Endocrinology
  • Diabetes Technology
  • Metabolic Disease Management

Background:

  • Hybrid closed loop (HCL) systems represent a significant advancement in managing type 1 diabetes (T1D).
  • Comparing the real-world performance of different HCL systems in pediatric populations is crucial for optimizing treatment strategies.

Purpose of the Study:

  • To compare glycemic control parameters across three distinct HCL systems in children with T1D.
  • To analyze data from a national pediatric diabetes registry to evaluate system effectiveness.

Main Methods:

  • Utilized population-wide data from the ČENDA registry for children with T1D (CwD) under 19 years old.
  • Included CwD using Medtronic MiniMed 780G, Tandem t:slim X2 (Control-IQ), or AndroidAPS (AAPS) for over 12 months with continuous glucose monitoring (CGM) >70% of the time.
  • Cross-sectional comparison of HbA1c, time in glycemic ranges, and Glycemia Risk Index (GRI) between systems.

Main Results:

  • Analyzed data from 512 CwD: 780G (42.4%), Control-IQ (41.2%), and AAPS (16.4%).
  • AAPS group showed the lowest HbA1c (44 mmol/mol), followed by Control-IQ (48 mmol/mol) and 780G (52 mmol/mol).
  • All systems achieved recommended time in range (75-78%). AAPS users experienced more hypoglycemia (5%) and had the highest GRI (32), while 780G users had the lowest GRI (27).

Conclusions:

  • All evaluated HCL systems effectively maintain recommended long-term glycemic control in children with T1D.
  • Observed differences highlight specific strengths and weaknesses of each system, aiding in personalized HCL system selection.
  • Findings support individualized decision-making for choosing the most appropriate HCL system based on patient needs and risk profiles.
Abstract

Keywords:
AndroidAPShybrid closed looppediatricsregistrytype 1 diabetes

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