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COMPARATIVE EFFICACY OF HYBRID CLOSED-LOOP INSULIN DELIVERY SYSTEMS (HCLS) AND SENSOR AUGMENTED PUMPS (SAP) AMONG PEOPLE WITH TYPE 1 DIABETES: A U.S. BASED MULTI-CENTER STUDY
Abstract
Background and Aims
Background and aims: Evidence from clinical trials have demonstrated the glycemic benefits of hybrid closed-loop insulin delivery systems (HCLS) in children and adults. The primary objective of this study was to provide real-world data on glycemic outcomes and population characteristics in those using HCLS compared to other treatment modalities.
Methods
Methods: Electronic health record data (2019-2021) from the T1D Exchange Quality Improvement (T1DX-QI) Collaborative were analyzed for 15,091 people with T1D. Patients with data on insulin delivery mode [HCLS, sensor augmented pump therapy (SAP), pump only, or multiple daily injections (MDI)], A1c at their most recent clinic visit, and other demographic covariates were included in this analysis. Individuals were classified across insulin delivery groups based on information documented by a healthcare provider at their most recent clinic visit.
Results
Results: In this study population, 744 (5%) were HCLS users, 2,326 (15%) were SAP users, 3,879 (26%) used pump only, and 8,142 (54%) were MDI users. Median (IQR) A1c in the HCLS group was 7.3% (IQR: 6.7,8.0%) compared to 8.0% (IQR: 7.2,9.1%) in the SAP group, 8.3% (IQR: 7.2,10.0%) in the pump only group and 8.7% (IQR: 7.4,10.5%) in the MDI group. Linear mixed models showed HbA1c to be 0.7% lower in the HCLS group compared to SAP, adjusting for age, gender, race/ethnicity and insurance status [Estimated Marginal Mean (95% CI): 7.8% (IQR: 7.3,8.4%) vs 8.7% (IQR: 8.2,9.0%)].
Conclusions
Conclusion: This is a large multi-site real-world study demonstrating significant clinical benefits of HCLS use relative to other insulin treatment options.
