Hybrid Closed-Loop Therapy in Adults With Type 1 Diabetes and Above-Target HbA1c: A Real-world Observational Study

Crabtree, Thomas S.J.; Griffin, Tomás P.; Yap, Yew W.; Narendran, Parth; Gallen, Geraldine; Furlong, Niall; Cranston, Iain; Chakera, Ali; Philbey, Chris; Karamat, Muhammad Ali; Saraf, Sanjay; Kamaruddin, Shafie; Gurnell, Eleanor; Chapman, Alyson; Hussain, Sufyan; Elliott, Jackie; Leelarathna, Lalantha; Ryder, Robert E.J.; Hammond, Peter; Lumb, Alistair; Choudhary, Pratik; Wilmot, Emma G.; Evans, Mark; Gurnell, Eleanor; Hartnell, Sara; Davenport, Katy; O’Reilly, Iona; Brown, Helen; Kamaruddin, Shafie; Pickering, Sharon; Abouglia, Kamal; Wadham, Claire; Rayman, Gerry; Hussain, Sufyan; Brackenridge, Anna; Pender, Siobhan; Atkinson, Rosarie; Bahadur, Melanie; Eid, Hatem; Carling, Janet; Oldfield, Linzi; Philbey, Christopher; Hammond, Peter; Haywood, Sean; Gallen, Geraldine; Rodgers, Helen; Lovie, Kaylee; Whight, Emma; Nobel-Bell, Georgia; Harris, Sophie; Cartwright, Anne; Garnett, Ian; Harvey, Jennifer; McCulloch, Frances; Yap, Yew Wen; Weston, Philip; Chapman, Alyson; Findlow, Lynne; Leel...

Abstract

OBJECTIVE
We explored longitudinal changes associated with switching to hybrid closed loop (HCL) insulin delivery systems in adults with type 1 diabetes and elevated HbA1c levels despite the use of intermittently scanned continuous glucose monitoring (isCGM) and insulin pump therapy.

RESEARCH DESIGN AND METHODS
We undertook a pragmatic, preplanned observational study of participants included in the National Health Service England closed loop pilot. Adults using isCGM and insulin pump across 31 diabetes centers in England with an HbA1c ≥8.5% who were willing to commence HCL therapy were included. Outcomes included change in HbA1c, sensor glucometrics, diabetes distress score, Gold score (hypoglycemia awareness), acute event rates, and user opinion of HCL.

RESULTS
In total, 570 HCL users were included (median age 40 [IQR 29–50] years, 67% female, and 85% White). Mean baseline HbA1c was 9.4 ± 0.9% (78.9 ± 9.1 mmol/mol) with a median follow-up of 5.1 (IQR 3.9–6.6) months. Of 520 users continuing HCL at follow-up, mean adjusted HbA1c reduced by 1.7% (95% CI 1.5, 1.8; P < 0.0001) (18.1 mmol/mol [95% CI 16.6, 19.6]; P < 0.0001). Time in range (70–180 mg/dL) increased from 34.2 to 61.9% (P < 0.001). Individuals with HbA1c of ≤58 mmol/mol rose from 0 to 39.4% (P < 0.0001), and those achieving ≥70% glucose time in range and <4% time below range increased from 0.8 to 28.2% (P < 0.0001). Almost all participants rated HCL therapy as having a positive impact on quality of life (94.7% [540 of 570]).

CONCLUSIONS
Use of HCL is associated with improvements in HbA1c, time in range, hypoglycemia, and diabetes-related distress and quality of life in people with type 1 diabetes in the real world.

Citation

Crabtree, T. S., Griffin, T. P., Yap, Y. W., Narendran, P., Gallen, G., Furlong, N., Cranston, I., Chakera, A., Philbey, C., Karamat, M. A., Saraf, S., Kamaruddin, S., Gurnell, E., Chapman, A., Hussain, S., Elliott, J., Leelarathna, L., Ryder, R. E., Hammond, P., Lumb, A., …Lambert, P. (2023). Hybrid Closed-Loop Therapy in Adults With Type 1 Diabetes and Above-Target HbA1c: A Real-world Observational Study. Diabetes Care, 46(10), 1831-1838. https://doi.org/10.2337/dc23-0635

• Journal Article Type: Article
• Acceptance Date: Jul 24, 2023
• Online Publication Date: Aug 11, 2023
• Publication Date: 2023-10
• Deposit Date: Feb 14, 2024
• Journal: Diabetes Care
• Print ISSN: 0149-5992
• Electronic ISSN: 1935-5548
• Publisher: American Diabetes Association
• Peer Reviewed: Peer Reviewed
• Volume: 46
• Issue: 10
• Pages: 1831-1838
• DOI: https://doi.org/10.2337/dc23-0635
• Keywords: Advanced and Specialized Nursing, Endocrinology, Diabetes and Metabolism, Internal Medicine
• Public URL: https://nottingham-repository.worktribe.com/output/24570469
• Publisher URL: https://diabetesjournals.org/care/article/46/10/1831/153467/Hybrid-Closed-Loop-Therapy-in-Adults-With-Type-1