Halis K Akturk, United States of America
Barbara Davis Center for Diabetes Adult ClinicAuthor Of 2 Presentations
OP014 - AUTOMATED THERAPY SETTINGS INITIALIZATION AND ADAPTATION WITH THE TANDEM T:SLIM X2 INSULIN PUMP WITH CONTROL-IQ TECHNOLOGY REDUCES HYPOGLYCEMIA WHILE MAINTAINING HIGH TIME IN RANGE (ID 166)
Abstract
Background and Aims
Determining user profile settings is an important part of insulin pump initiation and long-term use. We designed and evaluated an automated system to initialize and adjust insulin pump settings.
Methods
Adults with type 1 diabetes (N=29, mean age 35.4 (10.1) years, 62.1% female, diabetes duration 20.7 (11.2) years), completed 2 weeks of CGM run-in with multiple daily injections, then 13 weeks of Control-IQ technology use. Initial basal rate, carbohydrate ratio, and correction factor were determined by an algorithm based on prior insulin use, with follow-up settings adjusted weekly by the automated system. Providers could override the automated settings changes for safety concerns.
Results
Time 70-180 mg/dL (3.9-10 mmol/L) improved from 45.7% during run-in to 69.1% during the last 30 days of Control-IQ use. This improvement was evident after just one week (median improvement 18.8%, p<0.001, 95% CI 13.6 to 23.9). However time <70 mg/dL (<3.9 mmol/L) gradually decreased from 1.8% during run-in to 1.0% over 6 weeks and then stayed stable (p=0.03) (Table 1). Percentage of participants achieving HbA1c <7% (<53 mmol/mol) went from zero at baseline to 55% at study end (p<0.001). Only six of the 318 automated settings adaptations were manually overridden.
Conclusions
Automated therapy settings initialization and adaptation, implemented with Control-IQ technology, reduced hypoglycemia over time while showing immediate and sustained improvement in time in range. Use of this simplified technology may allow primary care and other providers, less comfortable with pump technology, to improve outcomes and reduce burden of care by increasing uptake of insulin pump use.
OP024 - PROGRESSION OF DIABETIC RETINOPATHY (DR) AFTER INITIATION OF AUTOMATED INSULIN DELIVERY (AID) SYSTEM IN ADULTS WITH TYPE 1 DIABETES (T1D) (ID 337)
Abstract
Background and Aims
Rapid improvement in A1c may worsen diabetic retinopathy (DR). However, the progression of DR and factors affecting it after initiation of AID systems, which are known to reduce A1c in T1D are unknown.
Methods
In this retrospective, longitudinal study, demographics, A1c, and eye exams were retrieved from electronic medical records of T1D adults who initiated AID between January 2020 and January 2022. DR worsening was defined as an increase in ETDRS scores and/or qualitative eye examination from the eye exam prior to AID initiation to the first eye exam following AID use.
Results
Of 152 T1D adults, 42 (28%) had DR worsening over mean 1.6 years. Those with DR worsening had higher baseline A1c, LDL, and eGFR (Table 1). In mixed models, there was no significant change in ETDRS score in either eye by time interval (p=0.3 for OS, p=0.4 for OD) or by A1c over time (p=0.5 for OS, p=0.4 for OD). In a logistic regression adjusted for age, duration, and sex, higher baseline A1c was associated with 2-fold increased risk for DR worsening (OR=2.1 [1.34-3.04], p=0.0008). Patients with LDL>100 and A1c >8% (n=16) had 3-fold increased risk for DR worsening (OR=3.33 [1.12-9.91], p=0.03).
Conclusions
Higher baseline A1c and LDL were associated with worsening of retinopathy after initiation of the AID system in adults with T1D. Further research is needed to evaluate the needed frequency of eye examination in high-risk patients.