Trial of Hybrid Closed-Loop Control in Young Children with Type 1 Diabetes.

BACKGROUND: Closed-loop control systems of insulin delivery may improve glycemic outcomes in young children with type 1 diabetes. The efficacy and safety of initiating a closed-loop system virtually are unclear. METHODS: In this 13-week, multicenter trial, we randomly assigned, in a 2:1 ratio, children who were at least 2 years of age but younger than 6 years of age who had type 1 diabetes to receive treatment with a closed-loop system of insulin delivery or standard care that included either an insulin pump or multiple daily injections of insulin plus a continuous glucose monitor. The primary outcome was the percentage of time that the glucose level was in the target range of 70 to 180 mg per deciliter, as measured by continuous glucose monitoring. Secondary outcomes included the percentage of time that the glucose level was above 250 mg per deciliter or below 70 mg per deciliter, the mean glucose level, the glycated hemoglobin level, and safety outcomes. RESULTS: A total of 102 children underwent randomization (68 to the closed-loop group and 34 to the standard-care group); the glycated hemoglobin levels at baseline ranged from 5.2 to 11.5%. Initiation of the closed-loop system was virtual in 55 patients (81%). The mean (±SD) percentage of time that the glucose level was within the target range increased from 56.7±18.0% at baseline to 69.3±11.1% during the 13-week follow-up period in the closed-loop group and from 54.9±14.7% to 55.9±12.6% in the standard-care group (mean adjusted difference, 12.4 percentage points [equivalent to approximately 3 hours per day]; 95% confidence interval, 9.5 to 15.3; P<0.001). We observed similar treatment effects (favoring the closed-loop system) on the percentage of time that the glucose level was above 250 mg per deciliter, on the mean glucose level, and on the glycated hemoglobin level, with no significant between-group difference in the percentage of time that the glucose level was below 70 mg per deciliter. There were two cases of severe hypoglycemia in the closed-loop group and one case in the standard-care group. One case of diabetic ketoacidosis occurred in the closed-loop group. CONCLUSIONS: In this trial involving young children with type 1 diabetes, the glucose level was in the target range for a greater percentage of time with a closed-loop system than with standard care. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases; PEDAP ClinicalTrials.gov number, NCT04796779.).

Bringing Simulation Technologies to People with T1D: A Pilot Study

Background: Researchers have extensively used metabolic simulators as a fast, inexpensive, and safe way of testing novel treatment strategies. This work aims to bring this technology to people with T1D to enable unique patient/data interactions. Methods: A 5-week pilot study was carried out in 15 adults with T1D using Control-IQ technology (age 36±13 years, HbA1c 6.5±0.7%) to evaluate acceptance of the proposed Web-Based Simulation Tool (WST). The study consisted of 1 week of observation (Phase 1) and 4 weeks of interaction with WST (Phase 2). Data were automatically collected via Tandem Diabetes Care t:connect web application, and used to generate personalized models of the participants' glucose metabolism. Results: Success rate in generating models was 86.4%, achieving an average MARD of 7.4±3.2%. Interaction time was 15.8±10.7 min per week. Comparing Phases 1 and 2, no variation was detected in time in range 70-180 mg/dl (80.1 [70.4,89.6]% vs. 80 [69.7,87.9]%). Time in 70-250 mg/dl increased slightly (94.2 [90.3,95.7]% vs. 96.2 [92.1,97.9]%), especially overnight (92.8 [88.3,98.2]% vs. 97.2 [91.8,99.6]%), and for participants who modified their pump settings based on WST simulations (90 [88.7,92.4]% vs. 94.5 [87.1,99.6]%). One subject tested COVID positive during the study and was excluded from this analysis due to abnormal hyperglycemia. Analysis of Diabetes Distress Scale (DDS)-17 pre and post-system use shows a reduction in diabetes-related distress (2.2 [1.7,3.4] vs. 2 [1.7,2.4]). Trust, ease of use, and usefulness scores were 80 [60,80]%, 60 [60,80]%, and 80 [60,80]%, respectively. During the follow up interviews, 10 participants reported they enjoyed using WST and would implement it into their diabetes management;2 did not like the system but see the potential of it for other people;3 participants did not like the system at all. Conclusions: Evidence from this study suggests that simulation technologies may empower people with T1D, making them more confident in their diabetes self-management.