Two-Year Real-Life Achievements of MiniMed 780G Advanced Closed-Loop System in Youth With Type 1 Diabetes: AWeSoMe...

To determine whether glycemic benefits of the MiniMed 780G Advanced Hybrid Closed-Loop system are sustained over 2 years in youth with type 1 diabetes, and to identify outcome predictors.

This prospective multicenter study collected continuous glucose monitoring (CGM) and clinical data at 1, 3, 6, 12, and 24 months in 96 children and adolescents with type 1 diabetes. Outcomes included hemoglobin A1c, CGM metrics, composite glycemic control score, glycemia risk index, composite CGM index, SmartGuard use, and anthropometric changes, analyzed by repeated-measures linear mixed models.

Hemoglobin A1c and time in range were maintained from 12 to 24 months, but time below range increased (1.8-2.5%, P = .015). Composite targets were rarely met: CGC by 14.6%, best GRI by 9.4%, best COGI by 10.4%. SmartGuard use declined from 91.3% to 82.7% (P = .013); lower socioeconomic position and lower 12-month SmartGuard use were independently associated with this decline. Girls had lower glycemic variability than boys and greater BMI z-score increase. Five DKA and 2 severe hypoglycemia events occurred, all device-or behavior-related.

The 780G Advanced Hybrid Closed-Loop system sustained meaningful glycemic benefits over 2 years, yet most youth failed to achieve optimal composite glycemic control. SmartGuard decline during the second year suggests the 12-month visit as a candidate checkpoint for monitoring device engagement, warranting evaluation in a future interventional trial.