TY - JOUR
T1 - Improved Glycemia with Hybrid Closed-Loop Versus Continuous Subcutaneous Insulin Infusion Therapy
T2 - Results from a Randomized Controlled Trial
AU - Garg, Satish K.
AU - Grunberger, George
AU - Weinstock, Ruth
AU - Lawson, Margaret L.
AU - Hirsch, Irl B.
AU - Dimeglio, Linda A.
AU - Pop-Busui, Rodica
AU - Philis-Tsimikas, Athena
AU - Kipnes, Mark
AU - Liljenquist, David R.
AU - Brazg, Ronald L.
AU - Kudva, Yogish C.
AU - Buckingham, Bruce A.
AU - McGill, Janet B.
AU - Carlson, Anders L.
AU - Criego, Amy B.
AU - Christiansen, Mark P.
AU - Kaiserman, Kevin B.
AU - Griffin, Kurt J.
AU - Forlenza, Greg P.
AU - Bode, Bruce W.
AU - Slover, Robert H.
AU - Keiter, Ashleigh
AU - Ling, Chenxiao
AU - Marinos, Briggitte
AU - Cordero, Toni L.
AU - Shin, John
AU - Lee, Scott W.
AU - Rhinehart, Andrew S.
AU - Vigersky, Robert A.
N1 - Publisher Copyright:
© Copyright 2023, Mary Ann Liebert, Inc., publishers 2023.
PY - 2023/1/1
Y1 - 2023/1/1
N2 - Objective: To evaluate safety and effectiveness of MiniMed™ 670G hybrid closed loop (HCL) in comparison with continuous subcutaneous insulin infusion (CSII) therapy for 6 months in persons with type 1 diabetes (T1D). Methods: Adults (aged 18-80 years), adolescents, and children (aged 2-17 years) with T1D who were using CSII therapy were enrolled and randomized (1:1) to 6 months of HCL intervention (n = 151, mean age of 39.9 ± 19.8 years) or CSII without continuous glucose monitoring (n = 151, 35.7 ± 18.4 years). Primary effectiveness endpoints included change in A1C for Group 1 (baseline A1C >8.0%), from baseline to the end of study, and difference in the end of study percentage of time spent below 70 mg/dL (%TBR <70 mg/dL) for Group 2 (baseline A1C ≤8.0%), to show superiority of HCL intervention versus control. Secondary effectiveness endpoints were change in A1C and %TBR <70 mg/dL for Group 2 and Group 1, respectively, to show noninferiority of HCL intervention versus control. Primary safety endpoints were rates of severe hypoglycemia and diabetic ketoacidosis (DKA). Results: Change in A1C and difference in %TBR <70 mg/dL for the overall group were significantly improved, in favor of HCL intervention. In addition, a significant mean (95% confidence interval) change in A1C was observed for both Group 1 (-0.8% [-1.1% to -0.4%], P < 0.0001) and Group 2 (-0.3% [-0.5% to -0.1%], P < 0.0001), in favor of HCL intervention. The same was observed for difference in %TBR <70 mg/dL for Group 1 (-2.2% [-3.6% to -0.9%]) and Group 2 (-4.9% [-6.3% to -3.6%]) (P < 0.0001 for both). There was one DKA event during run-in and six severe hypoglycemic events: two during run-in and four during study (HCL: n = 0 and CSII: n = 4 [6.08 per 100 patient-years]). Conclusions: This RCT demonstrates that the MiniMed 670G HCL safely and significantly improved A1C and %TBR <70 mg/dL compared with CSII control in persons with T1D, irrespective of baseline A1C level.
AB - Objective: To evaluate safety and effectiveness of MiniMed™ 670G hybrid closed loop (HCL) in comparison with continuous subcutaneous insulin infusion (CSII) therapy for 6 months in persons with type 1 diabetes (T1D). Methods: Adults (aged 18-80 years), adolescents, and children (aged 2-17 years) with T1D who were using CSII therapy were enrolled and randomized (1:1) to 6 months of HCL intervention (n = 151, mean age of 39.9 ± 19.8 years) or CSII without continuous glucose monitoring (n = 151, 35.7 ± 18.4 years). Primary effectiveness endpoints included change in A1C for Group 1 (baseline A1C >8.0%), from baseline to the end of study, and difference in the end of study percentage of time spent below 70 mg/dL (%TBR <70 mg/dL) for Group 2 (baseline A1C ≤8.0%), to show superiority of HCL intervention versus control. Secondary effectiveness endpoints were change in A1C and %TBR <70 mg/dL for Group 2 and Group 1, respectively, to show noninferiority of HCL intervention versus control. Primary safety endpoints were rates of severe hypoglycemia and diabetic ketoacidosis (DKA). Results: Change in A1C and difference in %TBR <70 mg/dL for the overall group were significantly improved, in favor of HCL intervention. In addition, a significant mean (95% confidence interval) change in A1C was observed for both Group 1 (-0.8% [-1.1% to -0.4%], P < 0.0001) and Group 2 (-0.3% [-0.5% to -0.1%], P < 0.0001), in favor of HCL intervention. The same was observed for difference in %TBR <70 mg/dL for Group 1 (-2.2% [-3.6% to -0.9%]) and Group 2 (-4.9% [-6.3% to -3.6%]) (P < 0.0001 for both). There was one DKA event during run-in and six severe hypoglycemic events: two during run-in and four during study (HCL: n = 0 and CSII: n = 4 [6.08 per 100 patient-years]). Conclusions: This RCT demonstrates that the MiniMed 670G HCL safely and significantly improved A1C and %TBR <70 mg/dL compared with CSII control in persons with T1D, irrespective of baseline A1C level.
KW - A1C
KW - Adult
KW - Diabetes treatment satisfaction
KW - Hybrid closed loop
KW - Pediatric
KW - Time below range
KW - Time in range
KW - Type 1 diabetes
UR - http://www.scopus.com/inward/record.url?scp=85145491610&partnerID=8YFLogxK
U2 - 10.1089/dia.2022.0421
DO - 10.1089/dia.2022.0421
M3 - Article
C2 - 36472543
AN - SCOPUS:85145491610
SN - 1520-9156
VL - 25
SP - 1
EP - 12
JO - Diabetes Technology and Therapeutics
JF - Diabetes Technology and Therapeutics
IS - 1
ER -