P-149: Beyond time in range: reducing glycemia risk index with automated hybrid closed-loop therapy in children under 7 years with type 1 diabetes
W N Laymoun, F S Alshawaf, I AlbasiriAbstract
Introduction
Achieving optimal glycemic control in young children with T1DM is challenging. The Glycemia Risk Index (GRI) provides an integrated assessment of hypoglycemia and hyperglycemia risk, complementing time-based metrics. Long-term real-world data on GRI and time in tight range (TITR) in children under 7 years using the MiniMed™ 780G remain limited.
Objectives
To evaluate longitudinal GRI and CGM metrics over 12 months following initiation of the MiniMed™ 780G (AHCL) system in children under 7 years with T1DM.
Methods
Prospective observational single-center study of 17 children with T1DM (< 7 years at initiation) transitioning from MDI or conventional CSII to MiniMed™ 780G AHCL. SmartGuard™ target was set at 100 mg/dL (n=13) or 110 mg/dL (n=4), and Active Insulin Time (AIT) was 2–3 hours. CGM metrics, and HbA1c were assessed at baseline, 3, 6, and 12 months. GRI was calculated at baseline and at 12 months.
Results
17 children were included. Mean age at diagnosis was 3.57 years, mean age at AHCL initiation was 5.42 years, and mean diabetes duration was 1.85 years. Median total daily insulin dose at baseline was 14.1 units/day. Over 12 months, there was a statistically significant improvement in both time in range (TIR), time in tight range (TITR) and HbA1c (p < 0.001), accompanied by a statistically significant reduction in coefficient of variation (CV) (p=0.002). There was no statistically significant change in time below range (TBR) (p = 0.25). GRI demonstrated a sustained shift toward lower-risk categories
Conclusions
Over 12 months, the MiniMed™ 780G system enabled proactive and sustained optimization of glucose control, with the majority of patients transitioning into lower glycemic risk categories. Importantly, improvements in time in range and HbA1c were achieved alongside reduced hypoglycemia exposure and significant stabilization of glycemic variability.