Baseline time in vary predicts synthetic pancreas success for youngsters with diabetes

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March 16, 2021

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Disclosure:
Tandem diabetes and the National Institute of Diabetes and Digestive and Kidney Diseases funded this study. Tandem provided the experimental closed-loop systems in the study, but system-related supplies, including Dexcom CGMs and Roche blood glucose meters, and technical expertise, were not involved in the data analysis. DeBoer reports that he has received grants from Medtronic and Tandem that have been paid to his facility. In the study you will find all relevant financial information from all other authors.

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A higher base time in the range is the strongest predictor of glucose response with a closed-loop insulin delivery system for children with type 1 diabetes. This is evident from data published in Diabetes Technology & Therapeutics.

In an analysis of 100 children with type 1 diabetes using the Control-IQ (tandem diabetes) artificial pancreatic system, the researchers also found that a lower base time in the area had the greatest improvement in reach in the area during the study was connected.

DeBoer is a Pediatric Endocrinologist at the University of Virginia Center for Diabetes Technology.

“Previous studies on the use of artificial pancreatic systems in children have focused on whether an artificial pancreas can provide better glucose control than people without an artificial pancreatic system. These studies have shown that artificial pancreatic systems keep patients in the target glucose range more than patients alone ” Mark D. DeBoer, MD, MSc, MCR, A pediatric endocrinologist at the University of Virginia’s Center for Diabetes Technology told Healio. “For this study, we had a unique opportunity to evaluate which factors help predict greater success for those using an artificial pancreatic system.”

DeBoer and colleagues analyzed data from 100 children aged 6 to 13 years with type 1 diabetes using the Control-IQ closed-loop system during a randomized study or a subsequent extension phase. Continuous glucose monitor data was collected at baseline and weeks 12 through 16 of closed-loop use. The researchers divided the participants into quartiles of time as they compared the control using a control loop.

The base time in the area predicts a regulation

The time spans for children in the first, second, third, and fourth quartiles were 54%, 65%, 71%, and 78%, respectively.

A lower baseline time in the range was associated with a lower time in the range at control (r = 0.69; P <0.001). However, a lower baseline time in the range was also associated with a greater improvement in time in the range at control (r = -0.81; P <0.001).

During the regimen, participants in the quartile with the highest or lowest amount of time administered more user-initiated boluses (8.5 versus 5.8; P <0.001) and received fewer automated boluses (3.5 versus 6; P <) each day. 001). Participants in the lowest (versus highest) quartile in the range received more insulin per body weight (1.13 versus 0.87 U / kg per day; P = 0.008). However, in a multivariate model that adjusted the base time in the range, user-initiated boluses and insulin were no longer significant per body weight.

“Perhaps the most important finding of the study wasn’t that surprising – that families who are most likely to do best with an artificial pancreatic system are those who have previously had good glucose control results,” DeBoer said. “These are families who are constantly thinking about their child’s glucose levels and how they can improve them. For example, they are more likely to give insulin for all food intake without lacking insulin for meals or snacks. “

Lower baseline control predicts improvement

However, DeBoer said it was noteworthy that children in this study who had a poor glucose response prior to using the artificial pancreas were the participants who experienced the greatest improvement.

“With the artificial pancreatic system, their glucose control was not as good as those who had good control without the artificial pancreatic system, but they experienced a bigger leap in their ability to keep glucose levels within target,” said DeBoer. “This was great message to diabetes care providers that even patients with poorer control would likely get significant benefits from the system initially.”

DeBoer said diabetes providers need to work with families to understand that while an artificial pancreatic system is helpful, it doesn’t work independently.

“Using an artificial pancreatic system won’t stop them from thinking about their child’s glucose control, getting insulin for all meals and snacks, and even thinking about whether or not their current doses need to be changed,” DeBoer said. “The system will help provide extra insulin to improve glucose counts. However, control is always best when the family continues to monitor glucose counts and talk about what they can do to improve their control levels.”

For more informations:

Mark D. DeBoer, MD, MSc, MCR, can be reached at mdd5z@hscmail.mcc.virginia.edu.

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