Endocrine Abstracts

Introduction: Hybrid closed loop (HCL) systems are made up of continuous glucose monitoring (CGM) sensor, an algorithm that receives the readings from the CGM and an insulin pump able to deliver variable insulin doses according to the information received from the other two parts. Predictive low-glucose suspend (PLGS) insulin pump is able to stop the administration of insulin before hypoglycemia occurs. These new technologies are meant to improve the quality of life and help the patient achieve better metabolic control and avoid hypoglycemia.

Materials and Methods: We performed a longitudinal retrospective study and included children with type 1 diabetes mellitus (DM1) that were admitted to our department in order to initiate PLGS or HCL insulin pump therapy. We evaluated the patients at baseline, when the insulin pump was initiated, and at follow-up, after minimum 3 months from baseline. At both moments we assessed the hemoglobin A1c (HbA1c) level and downloaded the Carelink reports that reflected the previous 90 days. The reports were available at baseline and both at follow up in 18 patients and included the parameters time in range (70-180 mg/dl) (TIR), time below range (TBR), time above range (TAR) and coefficient of variations (CV).

Results: 35 children were included in the study (65.7% females), and the mean age was 10.6±3.7 years. HCL pump (Medtronic 780G) was initiated in 13 patients, and PLGS insulin pump (Medtronic 640G and 740G) in 22 patients. Mean follow-up time was 8.5 months. At follow-up, all parameters were improved. HbA1c decreased significantly (7±0.9% vs 6.7±0.5%, P<0.03). Reports revealed that TIR increased significantly (69 ±13.7% vs 76.6±11, P< 0.001), with TBR and TAR significantly lower: TBR 5.3±3.4% vs 3.28 ±1.84%, P=0.02 and TAR: 25.2±15.5% vs 20.1±10.9%, P=0.02. CV also decreased significantly: 37.2±3.6% vs 35.2±4.2%, P=0.04.

Conclusion: In conclusion, HCL and PLGS insulin pumps improve metabolic control in children with DM1 and they help them achieve targets regarding glucose variability and time spent in normoglycemia, therefor avoiding short-term and long-term complications.