Real-World Evidence Supporting the Use of Advanced Hybrid Closed-Loop in Poorly Controlled Type 1 Diabetic Patients

Background: The advanced hybrid closed loop (a-HCL) algorithm of the MiniMed 780G includes automated basal and correction bolus insulin and offers the possibility to choose between three glucose targets. The aim was to evaluate the effectiveness of the a-HCL compared to its predecessors, the predictive low glucose suspension (PLGS, MiniMedTM 640G) and the standard hybrid closed loop (s-HCL, MiniMedTM 670G), and to assess which group of patients benefitted the most from the implementation of the a-HCL. Methods: Type 1 diabetes patients >18 years of age followed at the University Hospital Zurich (USZ), who initially used a PLGS or a s-HCL and were subsequently switched to the a-HCL until December 2021, were included in the study. Glucose metric data regarding HbA1c, time in range (TIR), time above range (TAR), time below range (TBR), average sensor glucose (SG), and variation coefficient (VC) was retrospectively analyzed before and after the conversion to the a-HCL. Results: 88 patients were screened, and 71 patients were included in the analyzes. After the implementation of the a-HCL, there was a significant decrease in HbA1c (pre 7.3±0.7% to post a-HCL 6.8±0.5%, p<0.001), SG (8.8±1.2 mmol/L to 7.9±0.8 mmol/L, p<0.001) and a significant increase in TIR (73.5% to 81%, p<0.001). Additionally, a significant decrease in TAR (23% to 17%, p<0.001) was observed, while TBR (1.5% to 1%, p=0.573) and the VC did not significantly change (33±6.6% to 32.4±5.8%, p=0.313). The changes in glycemic control were most pronounced in patients with a higher baseline HbA1c, a higher baseline SG, a lower baseline TIR, and a higher VC, all measures of poor glycemic control. Furthermore, patients with a body-mass index (BMI) >30kg/m2 achieved the greatest changes in HbA1c and TIR. Conclusion: In conclusion, our data support the use of a-HCL in all patients, but especially in poorly controlled type 1 diabetic patients with a high BMI. Disclosure G.Rathmes: None. S.F.Graf: None. C.Cavelti-weder: None.