Abstract

To assess the efficacy and safety of closed-loop control (CLC) insulin delivery system in adolescents and young adults with type 1 diabetes.Pre-specified sub-analysis of outcomes in adolescents and young adults 14-24 years old with type 1 diabetes in a previously published 6-month multicenter randomized trial. Participants were randomly assigned 2:1 to CLC (Tandem Control-IQ) or sensor augmented pump (SAP, various pumps+Dexcom G6 CGM) and followed for six months.Mean age of the 63 participants was 17 years, median type 1 diabetes duration was 7 years, and mean baseline HbA1c was 8.1%. All 63 completed the trial. Time in Range (TIR) increased by 13% with CLC versus decreasing by 1% with SAP (adjusted treatment group difference = +13% [+3.1 hours/day]; 95% CI 9% to 16%, P<0.001), which largely reflected a reduction in time >180 mg/dL (adjusted difference -12% [-2.9 hours/day], P<0.001). Time <70 mg/dL decreased by 1.6% with CLC versus 0.3% with SAP (adjusted difference -0.7% [-10 min/day], 95% CI -1.0% to -0.2%, P=0.002). CLC use averaged 89% of the time over 6 months. The mean adjusted difference in HbA1c after 6 months was 0.30% in CLC vs. SAP (95% CI -0.67 to +0.08, P=0.13). There was one DKA episode in the CLC group.CLC use over 6 months was substantial and associated with improved TIR and reduced hypoglycemia in adolescents and young adults with type 1 diabetes. Thus, CLC has the potential to improve glycemic outcomes in this challenging age group.

View details for DOI 10.1089/dia.2020.0572

View details for PubMedID 33216667