ESPE Abstracts

Introduction: Automated insulin delivery has demonstrated improved glycemic control in children and adolescents with type 1 diabetes mellitus (T1DM). The present analysis investigates real-world glycemic outcomes in children and adolescent on the MiniMed™ 780G advanced hybrid closed loop (AHCL) system after switching from MiniMed™ 640G predictive low glucose suspend system (PLGS) or MiniMed 670G hybrid closed loop (HCL) system and calibration-free glucose sensor Guardian 4 (G4) after switching from Guardian 3 (G3) glucose sensor within the single centre in Arendal, Norway

Methods: Retrospective analysis enrolled 29 children and adolescent (11 males and 18 females, mean age 12.7, range 7-17 years) with T1DM duration for >1 year and AHCL system >6 months. Pre-AHCL therapy included PLGS in 27 and HCL in 2 patients. Analysis included HbA1c (mmol/mol; immunoassay method in Siemens A1c Vantage Analyzer, Siemens Healthcare GmbH, Erlangen, Germany) and body mass index standard deviation score (BMI SDS) pre-AHCl, 3 and 6 months post-AHCL. Secondary analysis included 20 of those patients (9 males, 11 females, mean age 12.1, range 7-16 years) switched from G3 to G4. Analyses included HbA1c, percentage of time with sensor, percentage of time in target range (4-10 mmol/l), percentage of time in hypoglycaemia (≤3.9 mmol/l), the insulin dose (U/kg) and BMI SDS prior and 3 months post-G4.

Results: AHCL system showed a significant improvement in HbA1c compared to previous insulin therapy both after 3 and 6 months post-AHCL (53.0 mmol/mol, 95%CI 49.0-55.6 vs 50.5 mmol/mol, 95%CI 47.4-53.0; P=0.013; and 49.0 mmol/mol; 95%CI 44.7-51.0, P=0.0002, respectively). No statistically significant difference was found in HbA1c with AHCL and G4 compared to G3 glucose sensor, but significantly increase in TIR was achieved with G4 (54.5%, 95%CI 51.0-61.0 vs 67.5%, 95%CI 56.0-71.0, P=0.006). No statistically significant differences in percentage of time with sensor use, percentage of time spent in hypoglycaemia and insulin dose were found between the two sensors. BMI SDS increased but not significantly with the introduction of AHCL (Pre-AHCL: 0.49, 95%CI -0.12-1.11; post-AHCL 0.57, 95%CI 0.03-1.02; P=0.058), but reached statistical significance with use of G4 (Pre-G4: 0.53, 95%CI -0.08-1.69; post-G4 0.53, 95%CI 0.002-1.83; P=0.032).

Conclusion: The use of ACHL systems led to a significant improvement of glycemic control. Calibration-free glucose sensor G4 appears to be more effective in increasing TIR despite time of sensor use. During education in new technologies, an additional effort should be made for weight gain prevention.