P-16: Effectiveness of hybrid closed-loop systems in children and adolescents with type 1 diabetes
F Wasti, A Prakash, T Bhagat, S Belarmino, M Mesina, C Yau-piacentini, S Hachemi, A KshirsagarAbstract
Introduction
Hybrid closed-loop (HCL) systems integrate continuous glucose monitoring with insulin pump therapy to enable automated insulin delivery, reducing disease burden. Literature has shown a significant improvement in glycated haemoglobin (HbA1c) levels in children and young people (CYP) using HCL, however evidence beyond 1 year of use remains limited.
Objectives
The aim of this study is to assess glycated haemoglobin (HbA1c) levels in CYP using HCLs pre-initiation and at 3-6 months, 6-12months and >12 months post initiation.
Methods
CYP with type 1 diabetes that were started on HCLs were identified from clinic records. Patients without type 1 diabetes, 18 years of age or incomplete data sets were excluded. HbA1c levels were collected using both point-of-care and laboratory measurements at pre-initiation and follow up intervals (3–6, 6–12, > 12 months). Mean HbA1c was calculated at each interval and patients were stratified into the following distinct glycaemic ranges: <53mmol/mol, 54-57mmol/mol, 58-74mmol, >75mmol/mol.
Results
The study included a total of 69 CYP (25 male and 44 female), with mean age being 12.4 years. Most patients (65/69) used the Omnipod 5 with Dexcom G6 monitor. The mean HbA1c reduced from 72.2 mmol/mol pre-initiation to 57.2 mmol/mol at 3–6 months, 57.5 mmol/mol at 6–12 months, and 56.6 mmol/mol at >12 months. The proportion of patients achieving HbA1c <53 mmol/mol increased from 16.7% pre-HCL to 39% at 6–12 months and 34% at >12 months, while those with HbA1c ≥75 mmol/mol decreased from 38.9% to 2.9%.
Conclusions
HCL systems provide effective HbA1c reduction, but maintaining these gains remains a challenge post-six months. Clinical protocols should incorporate structured re-education at 12 months to ensure the durability of improved glycaemic outcomes.