Disclosures: Ju reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
December 22, 2021
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Nearly one-third of adults prescribed hybrid closed-loop system do not initiate auto mode

Disclosures: Ju reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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About 31% of a group of adults with type 1 diabetes prescribed a hybrid closed-loop insulin delivery system never initiated auto mode, and half of the never initiated group consisted of Black and Hispanic patients, according to study data.

“From our data, it is difficult to determine whether certain patients may have been more likely to have been offered 670G technology than others, although this is certainly plausible,” Zhihui Ju, MSPH, research coordinator in the section of endocrinology, diabetes, nutrition and weight management at Boston Medical Center, and colleagues wrote in a study published in Diabetes Technology and Therapeutics. “Nonetheless, most of our underserved population is still not receiving the potential benefits of advanced automated insulin delivery systems. Given the limited use of diabetes technology in our population, implementation of automated insulin delivery systems ... holds the potential for significant benefit, but also requires significant educational resources and support.”

About one-third of adults prescribed hybrid closed-loop system never start auto mode
Sensor functionality and family and life stressors were among the reasons adults prescribed a hybrid closed-loop system never started auto mode. Infographic content were derived from Ju Z, et al. Diabetes Technol Ther. 2021;doi:10.1089/dia.2021.0334.

Researchers conducted a retrospective observational study of 32 adults (69% women; 69% white; mean age, 36 years) with type 1 diabetes prescribed the Minimed 670G hybrid closed-loop system (Medtronic) at Boston Medical Center from September 2016 to January 2020. Clinical data were collected from electronic medical records, including sociodemographic information; number of visits with 1 year of prescription; HbA1c at baseline, 6 months and 12 months; and percentage of time spent in auto mode at last available clinic visit. Information from clinician notes was analyzed, with a focus on patient perceptions, satisfaction or challenges with the hybrid closed-loop system.

Of the study cohort, 69% initiated auto mode during the study period, with 77% of the auto mode initiation group consisting of white adults, 13.6% Black adults and 9% Hispanic adults. Of those who did not start auto mode, half were white adults, 30% were Hispanic adults and 20% were Black adults.

“It is concerning that nearly a third of our patients who received the 670G were not able to successfully initiate auto mode,” the researchers wrote. “In comparison with those who initiated auto mode, the groups were similar in all domains, except that 50% of those who never started were of Hispanic or Black ethnicity, compared with 23% of the group who initiated auto mode. Notably, in both groups, more than 90% were commercially insured and more than 50% held advanced educational degrees. Previous publications from our clinic have reported that although nearly 20% of Black patients had an annual household income in the highest bracket, none in this income bracket used any form of diabetes technology.”

The auto mode group spent more time in pump education than those who never started auto mode (139 minutes vs. 90 minutes). The group that never started auto mode had a lower baseline HbA1c than the auto mode initiation cohort (7.6% vs. 8.58%). At 1 year, the auto mode initiation group had a lower HbA1c than those who never started auto mode (7.11 % vs. 9.1%).

The reasons for never starting auto mode included sensor functionality and device frustration concerns, not getting the system to function consistently, life and family stressors and transfer to other health care facilities.

Of the 22 participants who initiated auto mode, five discontinued it during the 1-year follow-up period, despite spending more time in pump education that those who continued it (183 minutes vs. 123 minutes). The reasons for discontinuing auto mode included health insurance changes, frustration with pump-sensor interaction, changes in health unrelated to diabetes and transition to another pump or continuous glucose monitor.

“Given the potential for significant clinical benefit of automated insulin delivery systems in varied patient populations, future studies identifying barriers to and testing strategies for increasing use of advanced insulin delivery systems in underserved populations are needed,” the researchers wrote.