The effects of inpatient hybrid closed-loop therapy initiated within 1 week of type 1 diabetes diagnosis

Abstract

Background: This article describes our experience with inpatient hybrid closed-loop control (HCLC) initiated shortly after the diagnosis of type 1 diabetes in a randomized trial designed to assess the effectiveness of inpatient HCLC followed by outpatient sensor-augmented pump (SAP) therapy on the preservation of β-cell function.

Subjects and methods: Forty-eight individuals with newly diagnosed type 1 diabetes and positive pancreatic autoantibodies (7.8-37.7 years old) received inpatient HCLC therapy for up to 93 h, initiated within 7 days of diagnosis.

Results: On initiation of HCLC, mean glucose concentration was 240±100 mg/dL. During the first day of HCLC, median of the participant's mean glucose concentrations fell rapidly to 146 mg/dL, a level of control that was sustained on Days 2 and 3 (138 mg/dL and 139 mg/dL, respectively). By Day 3, the median percentage of glucose values >250 and <60 mg/dL was <1%. During the first 2 weeks of SAP treatment at home, the median participant mean glucose level was 126 mg/dL (interquartile range, 117, 137 mg/dL), and the median percentage of values between 71 and 180 mg/dL was 85% (interquartile range, 80%, 90%).

Conclusions: Inpatient HCLC followed by outpatient SAP therapy can provide a safe and effective means to rapidly reverse glucose toxicity and establish near-normal glycemic control in patients with newly diagnosed type 1 diabetes.

FIG. 1.

Participant mean glucose values from a continuous glucose monitor worn prior to admission, during hybrid closed-loop (HCL) control, and 2 weeks following discharge (n=48). The bottom and top of each box denote the 25^th and 75^th percentiles, respectively, the line inside the box denotes the median, and the dot is the mean.

FIG. 2.

Distribution of percentage of continuous glucose monitor glucose values 71–180 mg/dL from a continuous glucose monitor worn prior to admission, during hybrid closed-loop (HCL) control, and 2 weeks following discharge (n=48). The bottom and top of each box denote the 25^th and 75^th percentiles, respectively, the line inside the box denotes the median, and the dot is the mean.