P-400: Beyond glycemic control: real-world pediatric outcomes with advanced hybrid closed-loop insulin delivery in a tertiary center
A Alves Cabral, B de Melo Nunes, K de Souza Oliveira, I Aguiar Paiva, L Ignachiti Francisco, B Barone, D Christian de Arruda Costa, J Elmor Mainczyk, L Salomao Tyszler, J Veiga Moreira VasconcellosAbstract
Introduction
Automated insulin delivery (AID) systems improve glycemic control by increasing time in range (TIR) and reducing hypoglycemia in type 1 diabetes, but real-world pediatric data from middle-income countries remain limited and psychosocial outcomes are increasingly recognized as key components of diabetes care.
Objectives
This study aimed to evaluate glycemic and psychosocial outcomes after initiation of an advanced hybrid closed-loop (AHCL) system in pediatric patients at a tertiary care center.
Methods
This real-world case series included 7 pediatric patients with type 1 diabetes, that transitioned from multiple daily injections (MDI), Medtronic 640G or Roche Spirit Combo pumps to an AHCL system, the MiniMed 780G. Outcomes included HbA1c, TIR (70–180 mg/dL), time below range (TBR <70 mg/dL), time above range (TAR >180 mg/dL) and time in automated mode (TAM). Paired analyses were used (p<0.05). Psychosocial outcomes were assessed using a Likert-scale questionnaire completed by patients and caregivers, with 64% response rate.
Results
Mean HbA1c decreased from 8,6% to 7,9%. TIR increased from 51.5% to 72.6% while TBR was reduced by more than 50%. TAR decreased significantly from 44.7% to 24.9%. Improvements were observed across all patients, with greatest gains in those transitioning from multiple daily injections. Mean TAM was 92.7%, indicating high adherence and usability. Psychosocial assessment showed high satisfaction, with 69% of responses ≥4. Higher scores were observed in perceived glycemic control, autonomy and reduction in treatment burden. High engagement with automated mode likely contributed to increased autonomy, reduced caregiver burden, and greater confidence in diabetes management.
Conclusions
These findings support the effectiveness of AHCL systems in improving quality of life and psychosocial outcomes in real-world pediatric care. However, access to advanced diabetes technologies remains a major barrier in middle-income settings, limiting broader implementation despite clear clinical benefits.