Long-term real-life glycaemic outcomes with a hybrid closed-loop system compared with sensor-augmented pump therapy in patients with type 1 diabetes.

AIM: To compare glycaemic metrics at 3 and 6 months in patients with type 1 diabetes on a 670G hybrid closed-loop (HCL) system after using a sensor-augmented pump (SAP) for at least 3 months. MATERIALS AND METHODS: A retrospective study from a centre that has the largest number of 670G users in the United States was conducted. Data from 202 SAP users were reviewed. Sixty-one patients were excluded (two for steroid use, four for pregnancy, 27 for previous Enlite use, and 28 for non-continuous use of 670G). Out of 141 patients who met the inclusion criteria, 127 (aged 21-68 years) had complete data. RESULTS: HbA1c levels decreased by 0.4% at 3 months and were maintained at 6 months (7.6 ± 0.07 vs. 7.2 ± 0.08, P < 0.001) with no weight gain at 6 months. Time-in-range (70-180 mg/dL) increased from 59.5% ± 1.1% to 70.2% ± 1.2% and 70.1% ± 1.1% at 3 and 6 months (P < 0.001), respectively. At 6 months, time spent in hypoglycaemia (<70 mg/dL) and time spent in hyperglycaemia (>180 mg/dL) were reduced by 30% (2.2% ± 0.2% vs. 3.2% ± 0.2%; P < 0.05) and 26% (28.3% ± 1.2% vs. 38.1% ± 1.2%; P < 0.001), respectively. More time in auto-mode was associated with improved continuous glucose monitoring metrics, lower HbA1c and decreased glycaemic variability. Time in auto-mode declined in men after 3 months, while women maintained similar auto-mode use throughout the study. CONCLUSIONS: The HCL system improved HbA1c levels and time-in-range, and decreased time spent in hypoglycaemia and hyperglycaemia at 6 months. Auto-mode use was significantly correlated with continuous glucose monitoring metrics and glycaemic outcomes.

Using technology to advance type 1 diabetes care among women during the reproductive years and in pregnancy.

The prevalence of diabetes is increasing globally. Technology to improve care among individuals with diabetes is constantly being developed. Women living with Type 1 Diabetes Mellitus (T1DM) have unique challenges affecting their glucose control relating to menstrual cycles, pregnancy, and menopause. The purpose of this review is to examine the literature related to the use of technology to help women with T1DM manage their diabetes during the reproductive years, pregnancy, and beyond. Continuous subcutaneous insulin infusion (CSII) therapy can provider equivalent or better glucose control when compared with multiple daily injections (MDI), with less hypoglycemia, diabetic ketoacidosis, and weight gain. The CSII therapy has features that could help improve glucose control over the menstrual cycle, menopause, and pregnancy, although the most studied of these stages is pregnancy. Continuous glucose monitoring (CGM) can be combined with any insulin delivery system (MDI or CSII) to provide data on glucose values every few minutes and show glucose trends over time. CGM introduction can highlight glucose variability for women with T1DM, may be beneficial during pregnancy, and can reduce hypoglycemia. Sensor-augmented pump therapy and hybrid artificial pancreas (closed-loop) systems are promising tools that improve outcomes among individuals with diabetes. The use of modern technology to improve glucose and metabolic control among menopausal women with diabetes has not been well studied. Internet and phone-based technologies are emerging as important tools that may help with diabetes self-care for women living with diabetes.