Glycemic And Patient-Reported Outcomes After Transition To Advanced Hybrid Closed-Loop System In Patients After Total Pancreatectomy
Giona Castagna, Nicolò Diego Borella, Giuseppe Lepore, Michela Vergani, Lucrezia Zanchi, Michela Guizzetti, Domenico Pinelli, Roberto TrevisanAbstract
Objective
To evaluate glycemic and patient-reported outcomes associated with transition from multiple daily injections (MDI) to Advanced Hybrid Closed-Loop (AHCL) therapy in adults with diabetes shortly after total pancreatectomy (TP).
Research design and methods
In this single-center prospective observational study, 15 adults with diabetes after TP transitioned from MDI to AHCL therapy. The prespecified primary outcome was time in range (TIR; 70–180 mg/dL) during the first month of AHCL compared with the last month of MDI. Secondary outcomes included other continuous glucose monitoring (CGM) metrics, hypoglycemic events, and patient-reported outcomes; CGM outcomes were followed for 6 months. An exploratory comparison was also performed with 28 patients who remained on MDI.
Results
Median TIR increased from 53.9% to 72.0% (P < 0.01). TAR, mean glucose, GRI, and coefficient of variation also decreased (all P < 0.05), and CGM outcomes remained broadly stable throughout the 6-month follow-up. TBR and hypoglycemic-event frequency did not differ significantly. Median hypoglycemic-event duration decreased from 55.2 to 35.0 minutes (P < 0.01). Anxiety and fear of hypoglycemia decreased while other patient reported outcomes did not change significantly. In an exploratory comparison, AHCL recipients had higher TIR and lower GRI than 28 patients who remained on MDI.
Conclusions
In this selected cohort, transition to AHCL was associated with improved TIR and favourable changes in CGM-derived glycemic outcomes, without a significant increase in TBR. These exploratory findings suggest that AHCL may be a feasible therapeutic option for selected adults with diabetes after TP. Larger controlled studies are needed to confirm its clinical benefits and long-term sustainability.