Welcome to the ATTD 2023 Interactive Program

Abstract Body

A cohort of 120 pre-pubertal French children, aged 6-12 years, 45%F/55%M, with Type 1 diabetes since 5.1+/-2.2 years treated by continuous subcutaneous insulin infusion since 4.4+/-2.4 years, with HbA1c of 7.8+/-0.6%, were included in a 18-week randomized control study to assess 24/7 vs. evening and night Automated Insulin Delivery (AID) using Control-IQ algorithm and were further followed-up with free-life 24/7 AID for up to 83 to 101 weeks.

Under 24/7 AID with a mean of 94.1% of time in closed-loop, the time in 70-180 mg/dl target range (TIR) reached 67.5+/-5.6% after 18 weeks (+12.5% vs. baseline), while time below 70 mg/dl (TBR) was 2.6% (95%CI 1.9-3.6) (reduction by 41% from baseline) and mean HbA1c was reduced by 0.5%. TIR at night-time was 77.2 +/-7.7% and TBR 2.2% (95%CI 1.0-3.7). During the follow-up after 36 and 83-101 weeks, similar glucose metrics were sustained with no occurrence of severe hypoglycemia or ketoacidosis. Meanwhile, 45% of children entered in puberty with no impact on glucose control. During a 13-week period of closed-loop interruption, TIR and TBR went back to baseline levels, whereas a later 13-week confinement due to the COVID-19 pandemic while Control-IQ was active had no impact on TIR and TBR levels.

Our data shows that AID using active Control-IQ in free-life provides sustained improvement of glucose control with no safety concern in children, including during the pubertal period.

Abstract Body

In Belgium, we have 3 Automated Insulin Delivery (AID) systems: the Minimed Metronic 780G system, the Tandem Basal or Control IQ and the Diabeloop.

The Belgian federal health authorities have allocated a specific fixed budget for new technologies in the management of diabetes.
This budget covers the reimbursement of some of these technologies but only through specific centers recognized as experts in the field and designated by these same authorities.

Reimbursement of these AID devices is only available to people with type 1 diabetes and according to certain criteria.

These devices are only implemented in the hospital setting (either during hospitalization or as an outpatient). Education is also provided by these hospital teams and the equipment is provided by the hospital.

There is therefore no intermediary service provider, as in some countries. The budget allocated by the authorities therefore covers the purchase of the equipment by the hospital, as well as the multidisciplinary staff required for education, according to a fixed reimbursement.

Finally, the reimbursement of these technologies by the authorities is conditioned by the obligation to carry out a real-life study in order to judge the relevance of this type of treatment and to ensure the sustainability of the reimbursement in the future.

The objective of these studies will be briefly discussed.

Translated with www.DeepL.com/Translator (free version)

Abstract Body

AID experience in the real-world in the United Kingdom

Background

Hybrid closed loop (HCL) technology automates insulin delivery and improves outcomes in people living with Type 1 diabetes. We report real-world outcomes from adults with Type 1 diabetes with raised HbA1c despite insulin pump therapy and flash glucose monitoring.

Methods

A national clinical audit programme collected routine, anonymised clinical data submitted to a secure online tool. Reported outcomes include HbA1c, key glucose sensor metrics; Diabetes Distress Score; Gold Score; event rates (hospital admissions, paramedic callouts and severe hypoglycaemia) and user opinion of HCL.

Results

Follow up data were available from 520 HCL users; median age 40 (IQR 29-50) years, 67% female, mean diabetes duration of 21 (IQR 15-30) years, 85% white British. Baseline HbA1c 78.9±9.1mmol/mol [9.4±0.8%] reduced to 62.1±9.1mmol/mol [7.8±0.8%] at 5.1 (IQR 3.9-6.6) months median follow up. Mean adjusted HbA1c reduced by -18.1mmol/mol (95% CI -16.5, -19.6; P<0.001) [1.7% (95% CI 1.5, 1.8, P<0.001)]. Time in range (3.9-10mmol/l) increased from 34.2% to 61.8% (P<0.001), time below range (<3.9mmol/l) reduced from 2.1% to 1.6% (P<0.001). The proportion reporting diabetes-related distress reduced from 69.0% to 22.5%(P=0.001). Gold score reduced from 2.2 to 1.6 (P<0.001). Almost all (96.3%, 549/570) would recommend HCL to others with diabetes; 94.7% (540/570) reported that the system had a positive impact on their quality of life. No significant increases in hospital admissions/paramedic callouts were found.

Conclusion

The NHS England pilot of HCL therapy led to substantial improvements in HbA1c, time in range and time below range over 5 months of follow up. The prevalence of diabetes related distress improved. Almost all reported a positive impact on quality of life and would recommend the use of HCL system to other people living with diabetes.

Abstract Body

Over the past 5 years there has been an unprecedented acceleration of diabetes technology use before and during pregnancies complicated by type 1 diabetes (T1D). The CONCEPTT trial established the benefit of Continuous Glucose Monitoring (CGM) for improving maternal glucose and reducing neonatal morbidity in T1D pregnancy. However, many women struggled to achieve and maintain the mean CGM glucose and time in range (TIR) targets required for optimal obstetric and neonatal outcomes. Automated insulin delivery systems have the potential to support women to safely achieve the pregnancy glucose targets from early pregnancy. This session will review the experimental and real-world experience of using hybrid closed-loop systems during T1D pregnancy. It will examine which commercially available systems are suitable for use during pregnancy and explore the opportunities and barriers to rolling out closed-loop in routine antenatal care. It will report on healthcare professionals’ views about the training needed for hospital teams to support effective rollout of closed-loop systems including management of diabetic ketoacidosis (DKA) by emergency and maternity department staff, as well as inpatient hospital use following corticosteroids, and continuing closed-loop during and after labour/birth. We will report on how pregnant women engage with closed-loop and how its use during pregnancy affects their diabetes self-management, pregnancy experiences, interactions with healthcare teams and quality-of-life.