Objective:
Clinical trial data demonstrates improved glycemic control with hybrid close loop (HCL) insulin delivery systems, yet limited real-world data exists. Data from the inaugural cohort of patients initiating a HCL system (Medtronic MiniMed™670G, Medtronic Canada, Brampton, ON) at a university medical center was used to examine real-world utilization and glycemic control following a standardized implementation process.
Results:
Mean self-monitored blood glucose (SMBG) per day increased from 5.15 baseline to 6.49 at 6 to 12 weeks ( P <.05) with 3.26 sensor calibrations per day. Time-in-auto-mode was 79.3% at 2 weeks and 72.3% at final follow-up, with 82% of patients spending >50% of time in auto-mode. There were 8.2 auto-mode exits over the final 14-day download. Time-in-target was 67.3% in manual-mode, 73.4% at 2 weeks ( P = .09), and 71.7% by 6 to 12 weeks ( P = .06). Hemoglobin A1c (HbA1c) decreased by 0.51% ( P = .02), while total daily dose and % basal did not change. Patients with HbA1c <7.0% (53 mmol/mol) at baseline spent more time-in-target than those with HbA1c ≥7.0% (53 mmol/mol; 78.0% versus 67.5%) despite spending less time-in-auto-mode (66.5% versus 74.8%).
Thanks for the post, Khurt. My results are, thus far, pretty similar, except I am using Omnipod pump. My 2 week results were about 10% more in range than this particular study average. I have only been using it 2 weeks. You probably know that there will be an observational study released eventually with 1,000 participants. They are collecting data now.
I like the part you put in bold: “Patients with HbA1c <7.0% at baseline spent more time-in-target than those with HbA1c ≥7.0% despite spending less time-in-auto-mode (66.5% versus 74.8%).”
My relation to that:
I’ve had my new endo for a year now.
About 9 months in we got to talking about closed loop systems. She knows me at least a little by now. She told me I would almost certainly not be satisfied with any closed loop system and I would take it out of auto all the time and be doing manual tweaks all the time.
Better than in the past, but trying to improve going forward. However, I now have my own record of how I am achieving my goals which I can review on a daily basis.
