Outcomes of hybrid closed‐loop insulin delivery activated 24/7 versus evening and night in free‐living prepubertal children with type 1 diabetes: A multicentre, randomized clinical trial. Issue 3 (1st December 2021)

• Record Type: Journal Article
• Authors: Renard, Eric; Tubiana‐Rufi, Nadia; Bonnemaison, Elisabeth; Coutant, Régis; Dalla‐Vale, Fabienne; Bismuth, Elise; Faure, Nathalie; Bouhours‐Nouet, Natacha; Farret, Anne; Storey, Caroline; Donzeau, Aurélie; Poidvin, Amélie; Amsellem‐Jager, Jessica; Place, Jérôme; Breton, Marc D.
• Is Part Of: Diabetes, obesity & metabolism. Volume 24:Issue 3(2022)
• Page Start: 511
• Page End: 521
• Publication Date: 2021-12-01
• Subjects: children -- clinical trial -- closed‐loop -- glucose control -- type 1 diabetes; Diabetes -- Periodicals; Obesity -- Periodicals; Metabolism -- Disorders -- Periodicals; Clinical pharmacology -- Periodicals; 616.462
• DOI: 10.1111/dom.14605
• Languages: English
• ISSNs: 1462-8902

Abstract

Abstract: Aim: To assess the safety and efficacy of hybrid closed‐loop (HCL) insulin delivery 24/7 versus only evening and night (E/N), and on extended 24/7 use, in free‐living children with type 1 diabetes. Materials and Methods: Prepubertal children (n = 122; 49 females/73 males; age, 8.6 ± 1.6 years; diabetes duration, 5.2 ± 2.3 years; insulin pump use, 4.6 ± 2.5 years; HbA1c 7.7% ± 0.7%/61 ± 5 mmol/mol) from four centres were randomized for 24/7 versus E/N activation of the Tandem Control‐IQ system for 18 weeks. Afterwards, all children used the activated system 24/7 for 18 more weeks. The primary outcome was the percentage of time spent in the 70‐180 mg/dL glucose range (TIR). Results: HCL was active 94.1% and 51.1% of the time in the 24/7 and E/N modes, respectively. TIR from baseline increased more in the 24/7 versus the E/N mode (52.9% ± 9.5% to 67.3% ± 5.6% [+14.4%, 95% CI 12.4%‐16.7%] vs. 55.1% ± 10.8% to 64.7% ± 7.0% [+9.6%, 95% CI 7.4%‐11.6%]; P = .001). Mean percentage time below range was similarly reduced, from 4.2% and 4.6% to 2.7%, and the mean percentage time above range decreased more in the 24/7 mode (41.9% to 30.0% [–11.9%, 95% CI 9.7%‐14.6%] vs. 39.8% to 32.6% [–7.2%, 95% CI 5.0%‐9.9%]; P = .007). TIR increased through the whole range of baseline levels and always more with 24/7 use. The results were maintained during the extension phase in those initially on 24/7 use and improved in those with initial E/N use up to those with 24/7 use. Neither ketoacidosis nor severe hypoglycaemia occurred. Conclusions: The current study shows the safety and efficacy of the Tandem Control‐IQ system in free‐living children with type 1 diabetes for both E/N and 24/7 use; 24/7 use shows better outcomes, sustained for up to 36 weeks with no safety issues.