Endocrine Abstracts

Introduction: Currently, patients with type 1 diabetes (T1D) have the option of being treated with Hybrid Closed Loop (AHCL) systems, which allow insulin delivery to be modulated according to glycemic values. These systems do not allow any kind of anthropometric or laboratory characteristics to be used to enhance the devices’ capabilities. Thus, the aim of our study was to investigate the efficacy of AHCL systems in subjects with T1D and with obesity compared to normal-weight subjects in terms of metabolic control.

Methods: Forty-one subjects with T1D and normal weight (BMI 18.8-24.9 Kg/m²) or obesity (BMI 30.3-36.6 Kg/m²) were treated with AHCL and were enrolled in this retrospective observational study. BMI, fasting plasma glucose, Hba1c, lipid profile, creatinine, Time In Range 70-180mg/dl (TIR), Time above range with glycemia 180-250mg/dl (TAR ^180-250), Time above range >250mg/dl (TAR^>250), Time Below range with glycemia 70-54mg/dl (TBR ^70-54), Time Below range <70mg/dl (TBR^<54) and glycemic variability were assessed.

Results: We enrolled 41 subjects (13M/28F; age:47± 12 years; BMI: 26.7±4.9 kg/m2; mean duration of T1D: 26 ± 12 years). Hba1c (8.6±2% vs 7.4±0.8 %, P=0.021) and TG (122±70mg/dl vs 73±29mg/dl, P=0.012) were shown to be significantly higher in patients with obesity when compared to normal weight subjects while there were no differences in terms of fasting plasma glucose, total cholesterol, HDL, LDL and creatinine. AHCL prediction algorithms showed different efficacy in patients with obesity when compared with normal weight patients: although the TIR (mean 63.1±16.4), TAR^>250 (mean 9.2±10.5) and both TBR ^70-54 (mean 1.1±1.1) and TBR^<54 (mean 0,4±1) did not show statistically significant differences, patients with obesity when compared to normal weight patient showed higher TAR ^180-250 (23.9±8.3% vs 34.3±10.1%, P=0.003) and higher prevalence of high (>36%) glycemic variability (33.3% vs 66.7% P=0.05).

Conclusions: T1D subjects with obesity had worse glycemic control, evidenced not only by laboratoristic parameters such as higher levels of Hba1c and triglycerides but also by the higher TAR ^180-250 and greater presence of patients with high glycemic variability when compared with normal weight. This suggests that AHCL algorithms should also take into account the anthropometric characteristics of the subjects in order to better tailor insulin treatment.