P-154: Rapid and sustained improvement in time in range with hybrid closed-loop systems in children and adolescents: a real-world single-center study
M S Bauzá, A Iacopino, S Koziol, L PardoAbstract
Introduction
Hybrid closed-loop (HCL) systems improve glycemic control in children with type 1 diabetes (T1D), but real-world data remain limited.
Objectives
To evaluate effectiveness, safety, and achievement of glycemic targets in a pediatric cohort.
Methods
Retrospective study at a single center in Uruguay from 2023 to 2026. Forty patients with T1D, all younger than 14 years at HCL initiation using MiniMed 780G were included (50% female), including 7 aged 7 years or younger. Outcomes included time in range (TIR 70-180 mg/dL), time below range (TBR below 70 mg/dL), HbA1c, glucose management indicator (GMI), and insulin dose. All variables were analyzed at baseline, 3 months, 6 months, and 12 months. The proportion achieving TIR above 70% and TBR below 4% was assessed. The mean time in tight range (70-140 mg/dL) at 6 months was also analyzed. Statistical analysis included repeated-measures ANOVA and Pearson correlation.
Results
TIR increased from 52.5 +/- 10.5% to 71.2 +/- 7.9% at 3 months and 74.4 +/- 6.3% at 12 months, representing an increase of 21.9 percentage points (p < 0.001). The proportion of patients achieving TIR above 70% increased from 7.5% to 68.0%. HbA1c decreased from 8.9 +/- 1.0% to 7.2 +/- 0.6%, corresponding to a reduction of 1.7 percentage points. GMI improved early and remained stable over time (from 7.0 +/- 0.4% to 6.9 +/- 0.2%). The mean time in tight range (70-140 mg/dL) was 42.8 +/- 5.7%. TBR remained low, with 84.0% of patients achieving values below 4%. In children aged 7 years or younger, TIR increased from 44.2% to 73.2%. Two episodes of diabetic ketoacidosis were reported, with no severe hypoglycemia events.
Conclusions
HCL systems provide rapid, sustained improvements in glycemic control, including in young children, with a favorable safety profile. A rapid increase of more than 20 percentage points in time in range was achieved with no severe hypoglycemia in real-world pediatric patients.