Simplified Meal Management in Adults Using an Advanced Hybrid Closed-Loop System

Area of Science:

• Endocrinology
• Metabolic Diseases
• Biomedical Engineering

Background:

• Advanced hybrid closed-loop (AHCL) systems require meal announcements for optimal performance, posing a challenge for some individuals with type 1 diabetes (T1D).
• The MiniMed 780G AHCL system offers automated basal rates and corrections but relies on user input for meal carbohydrate (CHO) content.
• Accurate CHO counting can be burdensome, necessitating simpler meal announcement strategies for improved adherence and glycemic control.

Purpose of the Study:

• To compare glycemic control in adults with T1D using the MiniMed 780G AHCL system with simplified meal announcement versus precise CHO counting.
• To evaluate the efficacy of two simplified meal announcement methods: 'fixed one-step' and 'multistep' CHO entry.
• To assess the impact of simplified meal strategies on time in range (TIR), glucose management indicator (GMI), and hypoglycemia/hyperglycemia rates.

Main Methods:

• A study involving 14 adults with T1D evaluated glycemic control over 13 weeks of precise CHO counting, followed by two simplified phases: fixed one-step and multistep meal announcement.
• The fixed one-step phase involved a single preset CHO amount, while the multistep phase allowed for multiples of this preset based on meal size estimation.
• Glycemic control metrics including TIR, GMI, and hypoglycemia/hyperglycemia incidence were compared across the different meal announcement strategies.

Main Results:

• The fixed one-step simplified strategy showed similar TIR (75.4% vs. 77.7%) and slightly higher GMI (6.8 vs. 6.6) compared to precise CHO counting, with less hypoglycemia.
• The multistep simplified strategy resulted in superior TIR (80.5% vs. 77.7%) and identical GMI (6.6%) compared to precise CHO counting, with reduced level 1 hypoglycemia.
• Both simplified methods demonstrated acceptable safety profiles, with slight increases in hyperglycemia observed in the fixed one-step phase.

Conclusions:

• A simplified meal announcement strategy using the MiniMed 780G system, particularly the multistep approach, can effectively manage glycemic control in adults with T1D.
• The multistep strategy, utilizing increments of a fixed CHO amount, offers a viable alternative to precise CHO counting, potentially improving ease of self-care.
• The fixed one-step approach serves as a safe alternative for individuals facing greater challenges with mealtime self-management, meeting most glycemic targets.