Endocrine Abstracts

Aims: To evaluate real-world efficacy of closed-loop systems (CLS) (Minimed^TM 780G, DBLG1 -Diabeloop- and Control-IQ^TM Tandem) as well as to assess those predictive factors related with the achievement of near-normal glycemic control.

Methods: A prospective, longitudinal, and observational study was performed. It included T1D adults who initiated CLS between April and December 2021 in our hospital and provided data for ≧3 months (ninety of 130 CLS users were included). We evaluated the initial and three-months data regarding glycemic outcomes and their baseline characteristics.

Results: Ninety T1D were included (54 female, 45.1±11.5 years, 76.2±16.0 kg weigh, 27.4±4.9 kg/m² BMI, baseline HbA1c 7.5±0.9%). 41% were previously under multiple daily injections (MDI), 91% used continuous glucose monitoring (CGM) and 56% used an insulin bolus advisor. Different commercial CLS were used: 54 DBLG1, 18 Control-IQ^TM and 18 Minimed^TM780G.After three months, HbA1c significantly decreased to 6.9%±0.7% (-0.6%±0.1%, p<0.001). 58% achieved HbA1c<7%, 25% HbA1c 7-7.5% and 17% HbA1c>7.5%. Mean glucose management indicator (GMI) was 7.0%±0.4% (45% GMI<7%, 13% GMI=7% and 100% GMI≤7.9%). Mean time-in-range (TIR) was 73%±10% (67% TIR>70%) and mean time below range 54-69 mg/dl (TBR) was 1.4%±1.0%.Optimal glycemic control was observed among people with higher education level (GMI 6.8%±0.3% vs 7.1%±0.4%, p<0,04) and among people under 45 years old (HbA1c 6.7%±0.1% vs. 7.1%±0.1%, p<0.04).We observed a positive trend towards better glycemic control in women (TIR>70% 71% vs. 61%) and in those people who exercise regularly (HbA1c≤7% 75% vs. 54%; TBR<4% 0% vs. 8%)). Overweight didn’t affect glycemic control.Regarding prior treatment, a higher percentage of patients with insulin pump obtained optimal glycemic control compared with MDI (HbA1c≤6.5% 34% vs. 22%). Similarly, the previous use of insulin bolus advisor related to a higher proportion of optimal HbA1c (HbA1c≤6.5% 34% vs 21%).We observed a better glycemic control with the Minimed^TM780G system (GMI=6.7% vs. 7.0% DBLG1 and 7.0% Control-IQ^TM; TIR>70% 81% vs. 65% DBLG1 and 59% Control-IQ^TM (n.s.); better TAR and TBR, but no differences in HbA1c).

Conclusions: In almost all cases the use of a CLS improved glycemic control substantially. Factors that lead to an optimal glycemic control are higher education level, younger age and the CSL system used. Other factors that could influence glycemic outcomes are female sex, previous use of insulin pump and/or insulin bolus advisor and regular exercise.Partially funded by ISCIII (PI18/01118).