AHCL Insulin Delivery Linked to Better QOL, Metabolic Control in Children With T1D

The use of advanced hybrid closed-loop (AHCL) insulin delivery significantly improved quality of life (QOL) and metabolic control in children and adolescents with type 1 diabetes (T1D), according to a study published in Frontiers in Endocrinology.

Continuous glucose monitors and insulin pumps are often the first-line technological therapies for T1D management. More recently, systems have been combining the 2 into an automated closed-loop insulin delivery system, which has been deemed an acceptable therapeutic modality for T1D management and has been the focus of more recent T1D research.

According to the study authors, there is a growing body of evidence that AHCL systems simultaneously improve glycemic control regardless of baseline hemoglobin A_1c (HbA_1c) and decrease rates of hypoglycemic events.

The study included 24 children and adolescents with T1D aged between 10 and 18 years and using an insulin pump. Fourteen participants were female, with a mean (SD) age of 14.5 (1.7) years and a mean T1D duration of 7.2 (3.7) years.

All participants used a modified investigational version of the Minimed 780G AHCL and received structured education for 4 months.

The authors were able to access downloads from the participants’ previous sensor and insulin pumps, as well as clinical data from their electronic medical records. Participants answered 3 validated questionnaires—Children, Hypoglycemia Fear Survey (C-HFS); Problem Areas in Diabetes Scale 5-item short form (PAID-5); and World Health Organization Five Well-Being Index (WHO-5)—to assess the benefits of AHCL insulin delivery compared with a conventional therapy.

Based on these questionnaires, the authors found a significant decrease in participants’ fear of hypoglycemia, a reduction in emotional distress related to T1D, and an increase in general well-being. The significant decrease in fear of hypoglycemia was seen in both the behavior and worry subscales and in combined results.

They also saw an overall increase in the participants’ satisfaction and QOL, as well as less exhaustion, when using AHCL compared with conventional therapy.

“The participants were more rested, worried less about their illness, and consequently had more time for other things,” the authors said. “A notable improvement in the quality of sleep of both participants and their parents were reported.”

T1D management was found to be easier for children and adolescents using AHCL, as reflected by improved metabolic control.

The mean (SD) HbA_1c level was significantly lower at 4 months (7.74% [0.42%] or 61.1 [2.2] mmol/mol) compared with baseline (8.55% [1.34%] or 69.9 [12.3] mmol/mol).

Time in range was found to significantly differ between those who used conventional therapy (68.22% [3.69%]) and AHCL (78.26% [6.29%]) (P < .001). The time below range did not differ significantly between treatments, but time above range was significantly less for AHCL treatment.

None of the participants reported severe hypoglycemia or diabetic ketoacidosis.

The study’s main limitations include it being a single-center study with a small sample size and a short trial duration.

Reference

Gianini A, Suklan J, Skela-Savič B, et al. Patient reported outcome measures in children and adolescents with type 1 diabetes using advanced hybrid closed loop insulin delivery. Front Endocrinol (Lausanne). 2022;13:967725. doi:10.3389/fendo.2022.967725