Publications

Improvement of Care & Outcome

AUTOMATED INSULIN DELIVERY AT DIABETER

Pim Dekker, Tim van den Heuvel, Arcelia Arrieta, Javier Castañeda, Dick Mul, Henk Veeze, Ohad Cohen, Henk-Jan Aanstoot

Twelve-Month Real-World Use of an Advanced Hybrid Closed-Loop System Versus Previous Therapy in a Dutch Center For Specialized Type 1 Diabetes Care. Journal of Diabetes Science and Technology. 2024;0(0).

People with Type 1 diabetes (PWDs) face many challenges in achieving recommended glycemic goals. While continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) have offered improvements over traditional multiple daily injections (MDI), a majority of PWDs still struggle to meet the internationally established targets for glucose regulation. Recent developments in automated insulin delivery (AID) have resulted in improved glycemic outcomes, enhanced psychosocial well-being, patient satisfaction, and better sleep quality. Real-world evidence (RWE) studies are becoming increasingly important in diabetes care, complementing randomized controlled trials (RCTs). However, many RWE studies primarily focus on glucometrics without assessing the relationships between these metrics and clinical parameters such as HbA1c and prior treatment modalities. Those studies that do, are relatively small and data collection is often retrospective. The aim of this study, co-authored by Pim Dekker and Henk-Jan Aanstoot of Diabeter, was to analyze 12 months of prospectively collected real-world data from PWDs who initiated the MiniMed 780G (MM780G) system at the Diabeter clinic in the Netherlands.

Key findings:

The MM780G system resulted in significant improvements in glycemic control:
- HbA1c decreased from 7.6% to 7.1% after starting the MM780G system
- The percentage of PWDs with HbA1c less than 7% increased from 30% to 50%
- These improvements were seen across all age groups, including young children
- Participants who used the recommended system settings achieved even better results, with Time In Range (TIR) up to 77%
Improvements in glycemic control were sustained for at least 12 months
Participants who switched from older HCL systems (MM640G and MM670G) also experienced improvements in glycemic control
There was a slight decrease in TIR and Time in Tight Range (TITR) over the 12-month follow-up period, mainly in the 7-13 year and 14-21 year age groups
Older participants achieved better glycemic control than younger participants

Concluding, the authors state

"These results underscore the important role of optimal system settings to maximize outcomes. Future research should focus on predictors of aHCL AID treatment success, like system settings, weight, prior treatment modalities, and socioeconomic factors, to further optimize patient outcomes and develop tailored educational initiatives" -

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