Significant Improvement in Glycemic Control after Initiation of AHCL in Children with Type 1 Diabetes: A Single Center Prospective Study

Abstract

Objective: This study aims to investigate the early impact of advanced hybrid closed loop system (AHCL) in achieving and maintaining treatment goals in children with T1D. Materials and methods: A prospective longitudinal study was designed. Two separate analyzes were performed. The first one included the comparison of two systems in children with T1D who used to have Medtronic 640G system, then upgraded to the AHCL system, while the second analysis included the first 3 month-period analysis of glycemic parameters of children using AHCL, regardless their previous treatment before AHCL. Change in time in range (TIR) and a glucose management indicator (GMI) were compared at 3-month from baseline using t-test and Mann-Whitney U-test based on normality of the data. Results: The cohort-1 included the children (n = 25, age: 10.5 ± 2.5 years) who were transitioned from Medtronic 640G to AHCL. TIR (3.8-10 mmol/L) increased from 75.5 ± 10% at baseline to 80 ± 6.2% at 3 months (p = 0.008). The cohort-2 included 33 children (age: 12.1 ± 3.2 years) and a total of 2970 patient-days were analyzed. The mean TIR (3.8-10 mmol/L), was 79.8 ± ± 8.1%. The mean GMI was 6.6 ± 0.3%. The frequency of participants who had a GMI < 7%, time below range (TBR < 3.8 mmol/L) < 4% were 84.8% and 100%, respectively. The fraction of those who achieved the 3 glycemic targets (GMI < 7% and TIR > 70% and TBR < 4%) was 81.8%. Conclusions: This is the first study to report the positive impact of AHCL on the glycemic metrics of children with T1D from Turkey. Almost all children using AHCL have achieved glycemic targets and it is possible to achieve percentage of TIR which exceeds 80% with this system.