Hybrid Close-Loop Systems Versus Predictive Low-Glucose Suspend and Sensor-Augmented Pump Therapy in Patients With Type 1 Diabetes: A Single-Center Cohort Study

• Published in: Frontiers in endocrinology (Lausanne) Vol. 13; p. 816599
• Main Authors: Lunati, Maria Elena, Morpurgo, Paola Silvia, Rossi, Antonio, Gandolfi, Alessandra, Cogliati, Irene, Bolla, Andrea Mario, Plebani, Laura, Vallone, Luciana, Montefusco, Laura, Pastore, Ida, Cimino, Vincenzo, Argenti, Sabrina, Volpi, Graziella, Zuccotti, Gian Vincenzo, Fiorina, Paolo
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Media S.A 14.04.2022
• Subjects: Adult; Blood Glucose - metabolism; Blood Glucose Self-Monitoring; Cohort Studies; Cross-Sectional Studies; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - drug therapy; Endocrinology; Female; HCL; Humans; Insulin; insulin pump; Male; Middle Aged; PLGS; Quality of Life; Retrospective Studies; SAP; T1D; time in range; HCL; SAP; PLGS; T1D; insulin pump; time in range
• ISSN: 1664-2392; 1664-2392
• DOI: 10.3389/fendo.2022.816599

Predictive low-glucose suspend (PLGS) and hybrid closed-loop (HCL) systems may improve glucose control and quality of life in type 1 diabetic individuals. This is a cross-sectional, single-center study to compare the effect on metabolic control and glucose variability of PLGS and HCL systems as compared to standard sensor-augmented pump (SAP) therapy. We retrospectively analyzed 136 adults (men/women 69/67, mean age 47.3 ± 13.9 years) with T1D on insulin pump therapy, divided accordingly to type of insulin pump system ( : SAP, 24 subjects; : PLGS, 49 subjects; : HCL, 63 subjects). The groups were matched for age, gender, years of disease, years of CSII use, and CGM wear time. The analysis of CGM metrics, in the three groups, showed a statistically significant different percentage of time within the target range, defined as 70-180 mg/dl, with a higher percentage in group 3 and significantly less time spent in the hypoglycemic range in groups 2 and 3. The three groups were statistically different also for the glucose management indicator and coefficient of variation percentage, which were progressively lower moving from group 1 to group 3. In the HCL group, 52.4% of subjects reached a percentage of time passed in the euglycemic range above 70%, as compared to 32.7% in those with PLGS and 20.2% in those with SAP. A positive correlation between the higher percentage of TIR and the use of auto-mode was evident in the HCL group. Finally, the three groups did not show any statistical differences regarding the quality-of-life questionnaire, but there was a significant negative correlation between CV and perceived CSII-use convenience (r = -0.207, p = 0.043). HCL systems were more effective in improving glucose control and in reducing the risk of hypoglycemia in patients with type 1 diabetes, thereby mitigating risk for acute and chronic complications and positively affecting diabetes technologies' acceptance.