Are all HCL systems the same? long term outcomes of three HCL systems in children with type 1 diabetes: real-life registry-based study

Alzbeta Santova; Lukas Plachy; Vit Neuman; Marketa Pavlikova; Lenka Petruzelkova; Petra Konecna; Petra Venhacova; Jaroslav Skvor; Renata Pomahacova; David Neumann; Jan Vosahlo; Jiri Strnadel; Kamila Kocourkova; Barbora Obermannova; Stepanka Pruhova; Ondrej Cinek; Zdenek Sumnik

doi:10.3389/fendo.2023.1283181

Are all HCL systems the same? long term outcomes of three HCL systems in children with type 1 diabetes: real-life registry-based study

Front Endocrinol (Lausanne). 2023 Oct 16:14:1283181. doi: 10.3389/fendo.2023.1283181. eCollection 2023.

Authors

Alzbeta Santova^{1

2}, Lukas Plachy¹, Vit Neuman¹, Marketa Pavlikova³, Lenka Petruzelkova¹, Petra Konecna⁴, Petra Venhacova⁵, Jaroslav Skvor⁶, Renata Pomahacova⁷, David Neumann⁸, Jan Vosahlo⁹, Jiri Strnadel¹⁰, Kamila Kocourkova¹¹, Barbora Obermannova¹, Stepanka Pruhova¹, Ondrej Cinek¹, Zdenek Sumnik¹

Affiliations

¹ Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Prague, Czechia.
² 1st Faculty of Medicine, Charles University, Prague, Czechia.
³ Department of Probability and Mathematical Statistics, Faculty of Mathematics and Physics, Charles University, Prague, Czechia.
⁴ Department of Pediatrics, University Hospital Brno, Brno, Czechia.
⁵ Department of Pediatrics, University Hospital Olomouc, Olomouc, Czechia.
⁶ Department of Pediatrics, Masaryk Hospital, Usti nad Labem, Czechia.
⁷ Department of Pediatrics, University Hospital Plzen, Plzen, Czechia.
⁸ Department of Pediatrics, University Hospital Hradec Kralove, Hradec Kralove, Czechia.
⁹ Department of Pediatrics, University Hospital Kralovske Vinohrady, Prague, Czechia.
¹⁰ Department of Pediatrics, University Hospital Ostrava, Ostrava, Czechia.
¹¹ Department of Pediatrics, Hospital Ceske Budejovice, Ceske Budejovice, Czechia.

Abstract

Objective: To compare parameters of glycemic control among three types of hybrid closed loop (HCL) systems in children with T1D (CwD) using population-wide data from the national pediatric diabetes registry ČENDA.

Methods: CwD aged <19 years treated with Medtronic MiniMed 780G (780G), Tandem t:slim X2 (Control-IQ) or do-it-yourself AndroidAPS (AAPS) systems for >12 months and monitored by CGM >70% of the time were included. HbA1c, times in glycemic ranges, and Glycemia Risk Index (GRI) were used for cross-sectional comparison between the HCL systems.

Results: Data from 512 CwD were analyzed. 780G, Control-IQ and AAPS were used by 217 (42.4%), 211 (41.2%), and 84 (16.4%) CwD, respectively. The lowest HbA1c value was observed in the AAPS group (44 mmol/mol; IQR 8.0, p<0.0001 vs any other group), followed by Control-IQ and 780G groups (48 (IQR 11) and 52 (IQR 10) mmol/mol, respectively). All of the systems met the recommended criteria for time in range (78% in AAPS, 76% in 780G, and 75% in Control-IQ users). CwD using AAPS spent significantly more time in hypoglycemia (5% vs 2% in 780G and 3% in Control-IQ) and scored the highest GRI (32, IQR 17). The lowest GRI (27, IQR 15) was seen in 780G users.

Conclusion: Although all HCL systems proved effective in maintaining recommended long-term glycemic control, we observed differences that illustrate strengths and weaknesses of particular systems. Our findings could help in individualizing the choice of HCL systems.

Keywords: AndroidAPS; hybrid closed loop; pediatrics; registry; type 1 diabetes.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Blood Glucose
Blood Glucose Self-Monitoring
Child
Cross-Sectional Studies
Diabetes Mellitus, Type 1* / drug therapy
Glycated Hemoglobin
Humans
Hypoglycemia* / chemically induced
Hypoglycemia* / epidemiology
Insulin / therapeutic use
Insulin Infusion Systems
Registries

Substances

Glycated Hemoglobin
Blood Glucose
Insulin

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was supported by grants from the Czech Diabetes Society and the Czech Ministry of Health (conceptual support project to research organization 00064203 -FN Motol).