Effect of Sensor-Augmented Patch Pump with Predictive Low-Glucose Suspend Feature Compared to Multiple-Dose Insulin in Patients with Brittle Type 1 Diabetes

Objective: The conventional approach to brittle diabetes is the treatment of underlying causes and optimization with multiple-dose insulin injections. The goal of multiple- dose insulin therapy is to exactly mimic physiological insulin secretion; however, it often results in hypoglycemia. This study investigates the effectiveness of continuous subcutaneous insulin infusion therapy with a patch pump with the sensor augmented with predictive low- glucose suspend algorithm system in patients with uncontrolled type 1 diabetes who were treated with multiple-dose insulin and have high glycated hemoglobin values. Methods: The data of patients whose glycemic control could not be achieved with multiple-dose insulin therapy and who were switched to sensor-augmented tubeless pump with predictive lowglucose suspend feature (Medtrum A7+ TouchCare patch pump and integrated A7+ continuous glucose monitoring system) were analyzed retrospectively. Results: A total of 16 patients (male: 9; 56.3%) were included. After 3 months of the sensor-augmented pump with predictive low-glucose suspend treatment, patients'median (interquartile range) glycated hemoglobin level decreased to 7.55 (1.43) from 9.20 (3.55) (P =.008). Time below 56 mg/dL was 0.34%, time between 56 and 70 mg/dL was 1.01%, time between 70 and 180 mg/dL was 72.90%, time above 180 mg/dL was 25.67%, time between 70and 250 mg/dL was 95.98%, and time above 250 mg/dL was 2.76%. Conclusions: A pump system with predictive low-glucose suspend feature improves glycemic targets in patients with brittle uncontrolled type 1 diabetes without the expense of hypoglycemia compared to multiple-dose insulin treatment.