Disclosures: Tandem Diabetes and the National Institute of Diabetes and Digestive and Kidney Diseases funded this study. Tandem provided the experimental closed-loop systems in the trial, system-related supplies, including Dexcom CGMs and Roche blood glucose meters, and technical expertise, but was not involved in data analysis. DeBoer reports he has received grant support paid to his institution from Medtronic and Tandem. Please see the study for all other authors’ relevant financial disclosures.
March 16, 2021
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Baseline time in range predicts artificial pancreas success for children with diabetes

Disclosures: Tandem Diabetes and the National Institute of Diabetes and Digestive and Kidney Diseases funded this study. Tandem provided the experimental closed-loop systems in the trial, system-related supplies, including Dexcom CGMs and Roche blood glucose meters, and technical expertise, but was not involved in data analysis. DeBoer reports he has received grant support paid to his institution from Medtronic and Tandem. Please see the study for all other authors’ relevant financial disclosures.
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A higher baseline time in range is the strongest predictor of glucose response with a closed-loop insulin delivery system for children with type 1 diabetes, according to data published in Diabetes Technology & Therapeutics.

In an analysis of 100 children with type 1 diabetes using the Control-IQ artificial pancreas system (Tandem Diabetes), researchers also found that a lower baseline time in range was associated with the greatest improvement in time in range during the study.

DeBoer is a pediatric endocrinologist at the Center for Diabetes Technology at the University of Virginia.

“Previous studies about use of artificial pancreas systems in children have focused on whether an artificial pancreas can achieve better glucose control than what people are doing without an artificial pancreas system, and those studies have demonstrated that artificial pancreas systems keep patients in the target glucose range more than patients do on their own,” Mark D. DeBoer, MD, MSc, MCR, a pediatric endocrinologist at the Center for Diabetes Technology at the University of Virginia, told Healio. “For this study, we had a unique opportunity to evaluate what factors help predict a higher degree of success for those who go on an artificial pancreas system.”

DeBoer and colleagues analyzed data from 100 children aged 6 to 13 years with type 1 diabetes using the Control-IQ closed-loop system during a randomized trial or subsequent extension phase. Continuous glucose monitor data were collected at baseline and during weeks 12 through 16 of closed-loop control use. Researchers stratified participants into quartiles of time in range while using closed-loop control to compare clinical characteristics.

Baseline time in range predicts closed-loop control

Time in range for children in the first, second, third and fourth quartiles was 54%, 65%, 71%, and 78%, respectively.

Lower baseline time in range was associated with lower time in range on closed-loop control (r = 0.69; P < .001). However, lower baseline time in range was also associated with greater improvement in time in range on closed-loop control (r = –0.81; P < .001).

During closed-loop control, participants in the highest vs. lowest time-in-range quartile administered more user-initiated boluses daily (8.5 vs. 5.8; P < .001) and received fewer automated boluses (3.5 vs. 6; P < .001). Participants in the lowest (vs. the highest) time-in-range quartile received more insulin per body weight (1.13 vs. 0.87 U/kg per day; P = .008). However, in a multivariate model adjusting for baseline time in range, user-initiated boluses and insulin per body weight were no longer significant.

“The main finding of the study may not have been that surprising — that families that are most likely to do the best on an artificial pancreas system are those who were already doing well at glucose control beforehand,” DeBoer said. “These are families that are constantly thinking about their child’s glucose values and thinking about ways that they could improve those values. For example, they are more likely to give insulin for all food intake without missing insulin for any meals or snacks.”

Lower baseline control predicts improvement

However, DeBoer said, it was notable that children in this study who had poor glucose response before using the artificial pancreas were the participants who experienced the greatest improvement.

“On the artificial pancreas system, their glucose control was not as good as those who had achieved good control without the artificial pancreas system, but they experienced a bigger jump in their ability to maintain glucose values in the target range,” DeBoer said. “This was a great message to diabetes care providers, that even patients with poorer control initially were still likely to get significant benefits from the system.”

DeBoer said diabetes providers must work with families to understand that an artificial pancreas system, while helpful, does not work independently.

“Using an artificial pancreas system will not keep them from having to think about their child’s glucose control, making sure to get insulin for all meals and snacks and even thinking about whether the current doses need to be altered,” DeBoer said. “The system will help provide extra insulin to improve glucose numbers, but control will always be best if the family continues to pay attention to glucose numbers and talk about what they can do to improve their degree of control.”

For more information:

Mark D. DeBoer, MD, MSc, MCR, can be reached at mdd5z@hscmail.mcc.virginia.edu.