Diabetes technology & therapeutics最新文献

{"title":"Usability of Continuous Glucose Monitoring for Older Adults with Type 2 Diabetes: A Systematic Review.","authors":"April Savoy, Cristina Barboi, Melissa R Thomas, Michael Weiner","doi":"10.1177/15209156251369021","DOIUrl":"https://doi.org/10.1177/15209156251369021","url":null,"abstract":"<p><p>This systematic review aims to examine the use and usability of continuous glucose monitoring (CGM) among older adults with type 2 diabetes mellitus. The following databases, PubMed, Embase, and CINAHL, were searched for studies published between 2019 and 2024, and results were documented using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Eligibility criteria included English-language studies that researched the use and usability of CGM in adults 60 years or older with a minimum wear time of 2 weeks. We extracted usability (efficiency, effectiveness, and satisfaction) outcomes. Study quality was assessed using the Critical Appraisal Skills Program Checklist. Of the 118 identified titles, 58 articles underwent a full-text review, with seven being included in the final analysis. Studies evaluated clinical management of type 2 diabetes with CGM, assessing the following differences: CGM versus usual care, CGM across device types, and CGM across care models. Clinical effectiveness, based on glycated hemoglobin and time-in-range, and satisfaction were higher across CGM types compared with usual care. Based on descriptive measures, satisfaction was higher with real-time CGM than professional-mode CGM. Efficiency findings were not reported in the included studies. There were no findings on the effectiveness, efficiency, and satisfaction of ambulatory glucose profile (AGP) metrics. Although the clinical effectiveness of CGM among adults 60 years or older was demonstrated in the reviewed studies, our usability assessment is inconclusive. There is a gap in evidence related to the essential components that comprise the context of CGM use, which prohibits a complete usability assessment. Future studies are warranted to investigate CGM usability, emphasizing AGP metrics, to inform improvements and personalization for older adults.</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decision Support Tool for Self-Management of Insulin Dosing in Type 1 Diabetes with Multiple Daily Injections: A Proof-of-Concept Study.","authors":"Revital Nimri, Sarit Weizman Demri, Naama Fisch-Shvalb, Ido Muller, Anat Raz, Eran Atlas, Moshe Phillip","doi":"10.1177/15209156251380860","DOIUrl":"https://doi.org/10.1177/15209156251380860","url":null,"abstract":"<p><p><b><i>Objective:</i></b> To assess feasibility and safety of a decision support system (AI-DSS) that provides algorithm-generated insulin dosing recommendations directly to individuals with type 1 diabetes (T1D) managed with multiple daily injections (MDI). <b><i>Methods:</i></b> This single-arm, prospective proof-of-concept study included individuals with T1D managed with MDI and continuous glucose monitoring (CGM). Participants underwent a 4-week run-in period followed by a 12-week intervention phase, during which every two weeks algorithm-generated insulin titration recommendations were provided via a mobile application. CGM metrics were compared between the last 2 weeks of the run-in (baseline) and the last 2 weeks of the intervention periods. Primary safety outcomes included percent time <54 mg/dL and >250 mg/dL. Secondary outcomes included changes in HbA1c and time in range (TIR, 70-180 mg/dL). <b><i>Results:</i></b> The study cohort included 16 young adults (mean age 25.1 ± 4.1 years; 56% female, mean HbA1c 7.6% ± 0.8%) who completed the study. Median HbA1c significantly decreased from 7.5% (IQR: 7.1, 8) to 7.1% (IQR: 6.5, 7.3), from start to end of study (<i>P</i> = 0.013). TIR significantly improved by 3.5% ± 7.3% (<i>P</i> = 0.039). Time <54 mg/dL remained unchanged (0.9% ± 0.86% vs. 1.12% ± 1.11%; <i>P</i> = 0.191), with a trend toward reduced time >250 mg/dL (14.3% ± 10.71% vs. 12.32% ± 10.91%; <i>P</i> = 0.055). No severe adverse events were reported. <b><i>Conclusion:</i></b> Decision support tool for self-managed insulin dosing in individuals with T1D using MDI was feasible, safe, and improved glycemic control, supporting further evaluation in large-scale randomized trials.</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Who Benefits Most from Advanced Hybrid Closed Loop Therapy in Pregnancy Across Different Subgroups: A Secondary Analysis of the Randomized Controlled CRISTAL Trial.","authors":"Ina Geerts, Kaat Beunen, Mart Peeters, Nancy Van Wilder, Dominique Ballaux, Gerd Vanhaverbeke, Youri Taes, Xavier-Philippe Aers, Frank Nobels, Liesbeth Van Huffel, Joke Marlier, Dahae Lee, Joke Cuypers, Vanessa Preumont, Sarah E Siegelaar, Rebecca C Painter, Annouschka Laenen, Pieter Gillard, Chantal Mathieu, Katrien Benhalima","doi":"10.1177/15209156251379505","DOIUrl":"https://doi.org/10.1177/15209156251379505","url":null,"abstract":"<p><p><b><i>Objective:</i></b> The CRISTAL trial indicated that advanced hybrid closed loop (AHCL) therapy with MiniMed™ 780G in type 1 diabetes pregnancy did not improve time in range (TIRp) compared with standard insulin therapy (SoC), but improved TIRp overnight and reduced time below range (TBRp). We aimed to evaluate the effect of AHCL therapy across different subgroups. <b><i>Research Design and Methods:</i></b> This secondary analysis of the CRISTAL randomized controlled trial compared glycemic outcomes (TIRp, TIRp overnight, TBRp, and TBRp overnight) averaged over the antenatal period (14-, 20-, 26-, and 33-weeks' gestation) between the AHCL and SoC groups, within subgroups defined by baseline characteristics. <b><i>Results:</i></b> In women with baseline HbA1c <7.0%, the AHCL group (<i>n</i> = 35) had a significantly higher TIRp than SoC (<i>n</i> = 37), with a mean difference of 5.64% (95% confidence interval [95% CI]: 1.32-9.96), corresponding to 1 h 21 min more TIRp per day and 11.89% (95% CI: 7.01-16.76) higher TIRp overnight. In women without prior AHCL use, TIRp was 6.29% higher (95% CI: 0.90-11.68) and overnight TIRp 11.91% higher (95% CI: 5.65-18.16) in the AHCL group (<i>n</i> = 24) compared with SoC (<i>n</i> = 28). In women without higher education, AHCL users (<i>n</i> = 14) had a significantly higher TIRp compared with SoC (<i>n</i> = 14) with a difference of 7.33% (95% CI: 0.88-13.78). TBRp was significantly lower in AHCL users with baseline HbA1c <7.0% and in women without prior AHCL use. <b><i>Conclusions:</i></b> AHCL therapy improved glycemic management in pregnant women with baseline HbA1c <7.0%, in women without prior AHCL use, and in women without higher education, indicating that AHCL might particularly benefit these subgroups.</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using Nutrition to Improve Time in rangE (UNITE): A Randomized Clinical Trial with Continuous Glucose Monitoring in People with Type 2 Diabetes Not Taking Insulin.","authors":"Holly J Willis, Sally K Gustafson, Elizabeth Johnson, Meghan M JaKa, Richard M Bergenstal","doi":"10.1177/15209156251377799","DOIUrl":"https://doi.org/10.1177/15209156251377799","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Preliminary research suggests that continuous glucose monitoring (CGM) can be used to guide food and lifestyle choices. The objective of the Using Nutrition to Improve Time in rangE (UNITE) study was to compare the glycemic and dietary impact of using either a nutrition-focused approach (NFA) or a self-directed approach (SDA) during CGM initiation in people with type 2 diabetes (T2D) not on insulin. <b><i>Methods:</i></b> UNITE was a 60-day, two-arm, randomized clinical trial. The NFA arm was designed to help participants use CGM data to guide evidenced-based food choices to improve percent time in range with glucose 70-180 mg/dL (TIR70-180) and diet quality, whereas the SDA arm was designed to guide participants to use CGM data in any way that felt useful to them. Changes in outcomes from baseline (Base) to postintervention (Post) were estimated by arm and compared between arms using difference-in-differences; analyses were limited to those with adequate CGM data at Base and Post. <b><i>Results:</i></b> Adults (NFA: <i>N</i> = 64, SDA: <i>N</i> = 60) with a mean (standard deviation) age of 65.0 (10.3) years, T2D duration of 10.7 (6.5) years, and HbA1c of 7.9% (0.7) participated. There was no differential change in TIR70-180 between arms (<i>P</i> = 0.14), but both arms improved from Base to Post (NFA: 46%-71%, SDA: 55%-71%; within-arm differences both <i>P</i> < 0.001). Time with glucose >250 mg/dL decreased more from Base to Post in the NFA versus the SDA (-14% versus -6%; differential change <i>P</i> = 0.047). NFA participants had several minor, but significant, within-arm changes in dietary intake, and the NFA arm reported significantly more confidence using CGM data than the SDA arm (<i>P</i> < 0.05). <b><i>Conclusion:</i></b> Changes in mean TIR70-180 did not differ between the NFA and SDA arms; however, both arms experienced significant within-arm improvements, which support the use of CGM to improve glycemia in people with T2D not on insulin.</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Time-in-Range in Type 1 Diabetes: Projecting the Clinical and Cost Implications of Automated Insulin Delivery.","authors":"Sufyan Hussain, Asli Zeynep Ozdemir Saltik, Jessica J Yu, Simona de Portu, Richard F Pollock, Johannes Pöhlmann, Ohad Cohen","doi":"10.1177/15209156251380593","DOIUrl":"https://doi.org/10.1177/15209156251380593","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Time in range (TIR) has emerged as a key target in managing people with type 1 diabetes (PwT1D). The time spent in a glucose range of 70-180 mg/dL (3.9-10.0 mmol/L; TIR) is recommended to be >70%, which has been linked to reduced complication incidence. While frequently used in evaluating automated insulin delivery, TIR has rarely been applied in health economic assessments. This analysis therefore examined the impact of a 10-percentage point increase in TIR on clinical and economic outcomes for PwT1D. <b><i>Methods:</i></b> Four baseline TIR levels (50%, 60%, 70%, 80%) and the investigated TIR increase were mapped to glycated hemoglobin (HbA1c) using two published statistical approaches. HbA1c estimates informed the IQVIA CORE Diabetes Model, projecting cumulative complication incidence, life expectancy, quality-adjusted life expectancy (QALE), and costs over 20 years from an English public health care system perspective. Cohort baseline data, complication costs, and utilities were sourced from an economic assessment by the National Institute for Health and Care Excellence. Sensitivity analyses were performed to assess the robustness of results. <b><i>Results:</i></b> A 10-percentage point TIR increase reduced the cumulative incidence of complications, by 15.6%-53.0%, 8.8%-47.1%, 8.1%-33.5%, and 10.1%-17.6% for ophthalmic, renal, neuropathic, and cardiovascular complications, respectively, when averaged across baseline TIR levels. Fewer complications translated into life expectancy gains of 0.031-0.051 years and QALE gains of 0.056-0.143 quality-adjusted life-years, with higher gains for lower baseline TIR. Total projected cost reductions versus constant TIR were 7.5%-9.9%, driven by reduced complication costs. <b><i>Conclusions:</i></b> Long-term projections for England suggested that a 10-percentage point increase in TIR reduced diabetic complications in PwT1D, thereby reducing spending on complication treatment. Improvements were seen across baseline TIR levels but were disproportionately accrued in those with lower baseline TIR.</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145084988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Age at Diagnosis and Insulin Delivery Modality on Free-Living Glycemia in Type 1 Diabetes During Periods Associated with Dysglycemia: A Retrospective Analysis of the Type 1 Diabetes EXercise Initiative Study.","authors":"Guy S Taylor, Bram Burger, Jadine H Scragg, Ollie Page, Henry Schmid, Jeremie Nsengimana, Daniel J West, James A M Shaw","doi":"10.1177/15209156251370942","DOIUrl":"https://doi.org/10.1177/15209156251370942","url":null,"abstract":"<p><p><b><i>Objective:</i></b> To determine the impact of age at diagnosis and insulin delivery modality on free-living glycemia in type 1 diabetes overall and during common periods of dysglycemia (sleep, post-prandially, exercise). <b><i>Research Design and Methods:</i></b> Retrospective analysis of 4 weeks' free-living data from 423 people with type 1 diabetes duration >5 years within the T1DEXI Study. Participants were divided into putative age at diagnosis endotype groups: AgeDx^<7 (diagnosed <7 years old); AgeDx^7-12 (7-12 years); AgeDx^13-30 (13-30 years); and AgeDx^>30 (>30 years). Mixed-effects linear regression, fitted with a random effect for individuals and fixed effects for age at diagnosis groups, insulin delivery modality, and duration of diabetes, was used to analyze percentage time in different glycemic states over 24 h, during sleep/exercise, and for the 2 h post-prandially. <b><i>Results:</i></b> Participants using hybrid closed-loop systems spent more time in range (TIR: 70-180 mg/dL) than those using continuous subcutaneous insulin infusion alone (<i>P</i> < 0.001) or multiple daily injections (<i>P</i> < 0.001). TIR correlated positively with age at diagnosis and increased incrementally between diagnostic age groups overall (mean ± standard deviation, AgeDx^<7: 71.4 ± 16.0%, AgeDx^13-30: 73.0 ± 13.9%; AgeDx^>30 78.3 ± 14.1%), during exercise, while sleeping and post-prandially. Linear effects modeling confirmed higher TIR in AgeDx^>30 compared with AgeDx^<7 overall (12.3%, 95% confidence interval [CI] 4.9%-19.8%, <i>P</i> = 0.0002), during exercise (13.7%, 95% CI 5.3%-22.0%, <i>P</i> = 0.0002), while sleeping (11.0%, 95% CI 3.5%-17.0%, <i>P</i> = 0.0043) and post-prandially (14.9%, 95%CI 5.9 to 23.9%, <i>P</i> = 0.0001). AgeDx^13-30 spent more TIR than AgeDx^<7 during exercise (8.3%, 95% CI 1.9%-14.7%, <i>P</i> = 0.0050). <b><i>Conclusions:</i></b> In addition to insulin modality, age at type 1 diabetes diagnosis independently impacts on glycemia in adults and should be factored into personalized care planning.</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145085462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-World Effectiveness of the MiniMed™ 780G Advanced Hybrid Closed-Loop System for People ≥65 Years with Type 1 or Type 2 Diabetes in the United States.","authors":"Albert Chien, John J Shin, Margaret Liu, Arcelia Arrieta, Toni L Cordero, Andrine R Swensen, Robert A Vigersky","doi":"10.1177/15209156251376654","DOIUrl":"10.1177/15209156251376654","url":null,"abstract":"<p><p><b><i>Objective:</i></b> Multiple daily injections therapy in older adults with diabetes can negatively impact glycemic control and comorbidities. This issue may be overcome with advanced diabetes technology that reduces hypoglycemia and hyperglycemia. The present study evaluated real-world glycemic outcomes of a United States (US) cohort ≥65 years using the MiniMed™ 780G (MM780G) advanced hybrid closed-loop system. <b><i>Methods:</i></b> CareLink™ personal data as of December 18, 2024, for U.S. MM780G system users ≥65 years, were de-identified and analyzed. Metrics, including time in range (TIR 70-180 mg/dL), time in tight range (TITR 70-140 mg/dL), time below range 70 mg/dL (TBR70), and time above range 180 mg/dL and 250 mg/dL (TAR180 and TAR250, respectively), with and without recommended optimal settings (ROS, 100 mg/dL glucose target with 2 h active insulin time) were determined. Subanalyses based on age group (≥75 years) and type 1 diabetes (T1D) or type 2 diabetes (T2D) were, also, conducted. <b><i>Results:</i></b> The overall cohort (<i>n</i> = 8542) had a mean TIR, TITR, TBR70, TAR180, and TAR250 of 78.4%, 51.4%, 0.9%, 20.7%, and 3.6%, respectively, with a 6.8% glucose management indicator. For ROS users (<i>n</i> = 2753), TIR and TITR were higher (81.9% and 55.9%, respectively, <i>P</i> < 0.001), and TAR180 and TAR250 were lower (17.2% and 2.5%, respectively, <i>P</i> < 0.001). Data trended similarly among the population aged ≥75 years, and no differences were observed between T1D and T2D. <b><i>Conclusions:</i></b> In a real-world setting, a U.S. cohort aged ≥65 years using the MM780G system achieved consensus-recommended glycemic targets. Use of ROS enabled more users to achieve an even higher level of glycemic control.</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the Relationship Between Newly Defined Continuous Glucose Monitoring (CGM) Metrics and the Standard CGM Metrics in 30,000 People with Type 1 Diabetes.","authors":"Halis Kaan Akturk, Kagan Ege Karakus, Boyang Chen, Tomas C Walker","doi":"10.1177/15209156251377797","DOIUrl":"https://doi.org/10.1177/15209156251377797","url":null,"abstract":"<p><p><b><i>Background:</i></b> Rebound hyperglycemia (RHyper), rebound hypoglycemia (RHypo), extended hyperglycemia (EHyper), and extended hypoglycemia (EHypo) are newly defined continuous glucose monitoring (CGM) metrics. Here, we investigated the characteristics of these new metrics and the relationship between new CGM metrics and standard metrics. <b><i>Materials and Methods:</i></b> In this retrospective cohort study, 30,000 CGM users with at least 90 days of CGM data were randomly selected from Dexcom Clarity database. Standard and new CGM metrics were calculated for each user. Four different cutoffs were used to define RHyper and RHypo, and two cutoffs were used to define EHyper and EHypo events. The number of RHyper, RHypo, EHyper, and EHypo events per week, mean duration of events, and mean area under the curve of events were calculated. For rebound events, the rate of change (ROC) was calculated. Pearson correlation and simple linear regression were used to analyze the data. <b><i>Results:</i></b> Mean time in 70-180 mg/dL was 61.8 ± 20.7%, mean glucose was 173 ± 37.1 mg/dL, and coefficient of variation (CV) was 32.1 ± 7.2%. RHyper, RHypo, and EHyper were more frequent during daytime and increased throughout the day. EHypo mostly occurred during nighttime. CV correlated strongly with RHyper (70-180 mg/dL) events/week (<i>r</i> = 0.67) and RHypo (180 to 70 mg/dL) events/week (<i>r</i> = 0.64). Time in range had the strongest correlation with EHyper events/week (<i>r</i> = -0.88) among new metrics. RHyper events and RHypo events were strongly correlated with each other (<i>r</i> = 0.92). RHyper and RHypo ROC have a stronger correlation with CV than the correlation between CV and time below range (TBR) metrics. <b><i>Conclusions:</i></b> For rebound and extended metrics, the most important metric was the number of events/week. RHyper and RHypo had a stronger correlation with CV and hypoglycemia metrics (TBR) than the correlation between CV and TBR. Thus, rebound events have the potential to detect hypoglycemia events caused by glycemic variability. [Figure: see text].</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145063547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Glycemic Outcomes in Pediatric Type 1 Diabetes: A 2-Year Real-World Analysis of Different Automated Insulin Delivery Systems Generations.","authors":"Tim Lührs, Olga Kordonouri, Thekla von dem Berge, Kerstin Remus, Sarah Biester, Kerstin Kapitzke, Thomas Danne, Felix Reschke, Mareike Niemeyer, Jantje Weiskorn, Torben Biester","doi":"10.1177/15209156251376708","DOIUrl":"https://doi.org/10.1177/15209156251376708","url":null,"abstract":"<p><p><b><i>Objective:</i></b> To evaluate long-term changes in glycemic control after switching from nonautomated insulin therapy to various automated insulin delivery (AID) systems in children and adolescents with type 1 diabetes (CwD). <b><i>Research Design and Methods:</i></b> This monocentric retrospective study included CwD under 20 years of age previously treated with multiple daily injections, continuous subcutaneous insulin infusion, or predictive low glucose management systems. Real-world data from 12 to 24 months following transition to AID were analyzed. Systems included the calibration-requiring Medtronic MiniMed™ 670G and noncalibration systems Medtronic MiniMed™ 780G and Tandem Control-IQ. Outcomes assessed included hemoglobin A1c (HbA1c), time in range (TIR), mean glucose, coefficient of variation, glycemia risk index (GRI), body mass index standardized deviation score, and total daily dose (TDD) of insulin. Nonparametric tests assessed between-system differences and longitudinal changes. Multiple linear regression analyses were performed to investigate factors influencing HbA1c. <b><i>Results:</i></b> Among 305 CwD initiating AID between 2019 and 2022, 83 (27.2%) used 670G and 222 (72.8%) used noncalibration systems. Across all groups, AID use led to significant improvements in TIR, time above range (181-250 mg/dL), time below range (<54 mg/dL), mean glucose, and GRI (all <i>P</i> < 0.001). HbA1c declined during the first year but regressed toward baseline in the second year (<i>P</i> < 0.001). At 24 months, noncalibration systems outperformed the 670G, showing lower HbA1c (7.4% vs. 7.8%, <i>P</i> = 0.021), reduced TDD (0.78 vs. 0.85 IU/kg/day, <i>P</i> = 0.022), and greater time in automated mode (95% vs. 73%, <i>P</i> < 0.001). Baseline HbA1c, AID type, and age were significant predictors of 24-month HbA1c. <b><i>Conclusions:</i></b> AID systems improve key glycemic outcomes and reduce hypoglycemia compared with prior therapies. Noncalibration systems demonstrate superior performance over time. However, the initial HbA1c benefits wane after the first year, highlighting the need for strategies to sustain long-term metabolic improvements.</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145063522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Switch of Open-Source Automated Insulin Delivery (AID) System-AndroidAPS to Commercially Available AID Systems in Type 1 Diabetes: The Extension of the CODIAC Study.","authors":"Quoc Dat Do, Lucie Radovnická, Aneta Hásková, Judita Konečná, Eva Horová, George Grunberger, Martin Prázný, Christopher G Parkin, Milan Flekač, Jan Šoupal","doi":"10.1177/15209156251376013","DOIUrl":"https://doi.org/10.1177/15209156251376013","url":null,"abstract":"<p><p><b><i>Objective:</i></b> This study was designed to investigate the switch between the open-source automated insulin delivery (OS-AID) system AndroidAPS (AAPS) and commercially available AID systems Control-IQ (CIQ) and MiniMed 780G (780G) conducted in a new extended follow-up study. <b><i>Research Design and Methods:</i></b> In this prospective open-label single-arm clinical trial, 41 adults with type 1 diabetes (age 35 ± 11 years, glycated hemoglobin [HbA1c] 6.4 ± 2.8% [46 ± 6.8 mmol/mol]) who have voluntarily used AAPS entered a total of three study phases. In the first phase, participants continued with AAPS for 3 months. In the second 3-month study phase, all participants initiated CIQ (<i>n</i> = 25) or 780G (<i>n</i> = 16). Finally, participants were switched back to the AAPS for the last 3 months phase. Results of the treatment with commercially available AID systems were compared with both AAPS phases. <b><i>Results:</i></b> Commercially available systems were comparable to AAPS in achieving time in range (TIR) (84.2 ± 7.6 vs. 85 ± 6.9%; <i>P</i> = 0.31) and in HbA1c (6.4 ± 3 vs. 6.3 ± 2.7% [46 ± 8.8 vs. 45.7 ± 6.2 mmol/mol]; <i>P</i> = 0.68). In contrast, time in tight range (TITR) was significantly higher in AAPS (66.38 ± 11.84 vs. 63.4 ± 11.77, <i>P</i> = 0.035). However, the time in hypoglycemia <70 mg/dL [<3.9 mmol/L] was significantly lower with commercially available AID systems (2.2 ± 1.2 vs. 3.8 ± 1.9%; <i>P</i> < 0.001). These results were consistent after switching back to AAPS. <b><i>Conclusion:</i></b> The extension of the Comparison of Different Hybrid Closed-Loop Systems-AndroidAPS and Control-IQ-in adults with Type 1 Diabetes study is the only prospective study to investigate switching between OS and commercially available AID systems. The switch from AAPS to commercially available systems was not associated with a change in TIR. However, the use of AAPS was associated with a higher TITR, but also with a higher risk of hypoglycemia.</p>","PeriodicalId":11159,"journal":{"name":"Diabetes technology & therapeutics","volume":" ","pages":""},"PeriodicalIF":6.3,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145032950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}