Abstract Body

Fully automated closed-loop insulin delivery in the inpatient setting has been shown to be safe and effective. The use of inpatient closed-loop therapy is associated with significantly improved glycaemic control compared to standard insulin therapy without increasing the risk of hypoglycaemia, including in those requiring nutrition support (enteral and parenteral nutrition) or haemodialysis during their admission. Closed-loop systems may provide an important opportunity to address the challenges associated with inpatient diabetes management.

In this talk we review the available evidence from randomised clinical trials, and report on our experience of implementation of inpatient closed-loop technology in a real-world setting. We will discuss key considerations for healthcare providers to adopt inpatient closed-loop technology.

Background and Aims

Older adults with type 1 diabetes (T1D) have distinct characteristics that can make optimising glycaemic control challenging. We hypothesised that hybrid closed-loop is safe and more effective than sensor-augmented pump (SAP) therapy in older adults with T1D.

Methods

In a multicentre, multinational (UK and Austria), randomised, crossover study, adults aged 60 years and over with T1D using insulin pump therapy underwent two 16-week periods comparing hybrid closed-loop (CamAPS FX) and SAP therapy in random order. The primary endpoint was the proportion of time sensor glucose was in target range between 3.9 and 10.0mmol/L. ClinicalTrials.gov NCT04025762.

Results

Thirty-seven participants (mean±SD age 67±5 years, baseline HbA1c 7.4±0.9% [57±10mmol/mol]) were randomised between 4 September 2019 and 2 October 2020. The proportion of time glucose was between 3.9 and 10.0mmol/L was 8.6 percentage points (95% CI 6.2 to 11.0) higher during closed-loop compared to SAP (p<0.001). Time with glucose >10.0mmol/L was 8.4 percentage points lower (95% CI -11.0 to -6.0; p<0.001), mean glucose was 0.7mmol/L lower (95% CI -0.9 to -0.5; p<0.001), and glycated haemoglobin was 0.2% lower (95% CI -0.4 to -0.1; p<0.001) with closed-loop than with SAP. Time in hypoglycaemia (<3.9mmol/L) was similar between periods (p=0.54). Two severe hypoglycaemia events occurred during the SAP period. There were no other treatment related serious adverse events.

Conclusions

Hybrid closed-loop insulin delivery is safe and achieves superior glycaemic control than SAP therapy without increasing the risk of hypoglycaemia in older adults with T1D.

Funding: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)