IMPE Abstracts

Introduction: The optimal control of type 1 diabetes mellitus (DM1) has been a challenge over time, especially in the pediatric population. A high proportion of patients do not achieve glycemic targets, which has led to the search for new strategies to optimize metabolic control. Recently, advanced hybrid closed-loop system (AHCL) have been designed to combine automated basal insulin delivery with automated five-minute correction boluses integrated to continuous glucose monitoring (CMG). Several studies in children and adults have shown that AHCL improves glycemic control without increasing hypoglycemia by optimizing time in range (TIR). The new Minimed 780G AHCL insulin pump (Minimed Medtronic, Northridge, California) is available in Colombia since January 2022, and can be used as a treatment option in pediatric patients with DM1.

Objetive: The aim of the study was to evaluate the impact on glycemic control, assessed by CMG and HbA1c metrics, when switching patients with DM1 from other treatment modalities to the new Minimed 780G technology in a national diabetes training center.

Methods: Between April and July 2022, 10 patients under 18 years of age with DM1, previously treated with multiple daily insulin injections (MDI) or other insulin pump system (Minimed 640G) who followed a structured training plan to switch to Minimed 780G AHCL insulin pump in a national center, were recruited. Data was extracted from CMG metrics before initiation of Minimed 780G, at 4 and 12 weeks after initiation of the new technology. HbA1c values before and 12 weeks after initiation of Minimed 780G were also collected.

Results: Four patients were lost to follow-up after 4 weeks of training and 6 patients were followed up to 12 weeks. TIR increased in half of the patients from 37% ± 3.6% at baseline to 61.2% ± 5.8% at the 4-week follow-up and increased in all patients who completed the 12-week follow-up from 63.7% ± 18.6% at baseline, to 80.5% ± 12.6%. Estimated HbA1c derived from glucose mean (GMI) decreased from 7.5 ± 0.64% at baseline to 6.3 ± 0.38% at the end of the 12-week follow-up. GMI did not correlate with the HbA1c value in 2 of the patients. No severe hypoglycemias or episodes of diabetic ketoacidosis were reported.

Conclusions: Switching to an AHCL in a real-life group of children and adolescents who followed a structured training plan, led to a rapid improvement in glycemic control seen at 4 weeks, and maintained up to 12 weeks regardless of prior insulin treatment and the basal conditions.