Time With Glucose Level in Target Range Among Children and Adolescents With Type 1 Diabetes After a Software Update to a Closed-Loop Glucose Control System

For people with type 1 diabetes, the percentage of time in range (TIR; 70-180 mg/dL [to convert to millimoles per liter, multiply by 0.0555]) is recognized as the most effective metric with glycated hemoglobin to assess glycemic control.1 Closed-loop control systems, such as the t:slim X2 insulin pump with Control-IQ technology (Tandem Diabetes Care Inc), have been reported to increase TIR by 9% among children and adolescents with type 1 diabetes,2 despite the difficulty in achieving glycemic targets in this age group.3,4 Education is also important to optimize glucose control when a new technology is adopted.5,6 We therefore analyzed immediate changes in TIR among a group of children and adolescents with type 1 diabetes switching from Tandem Basal-IQ technology toControl-IQ technology

Comment on “Real-World Use of a New Hybrid Closed Loop Improves Glycemic Control in Youth with Type 1 Diabetes” by Messer et al

We read with interest the article by Messer et al.1 reporting a significant increase in time in range (TIR, +9%, P < 0.001) in 191 children and adolescents using a closed-loop control (CLC) system (Tandem t:slim X2 insulin pump with Control-IQ technology, San Diego, CA). This result is noteworthy given the difficulties in achieving good glycemic control, especially in children.2,3 In addition to technology, we believe that education, especially when designed for sharing between pediatric centers, can maximize the benefits of new diabetes technology. To this end, in 2020 and at the same time as CLC with the Control-IQ system was introduced in Italy, we organized a virtual educational camp (vEC) for children and adolescents with type 1 diabetes. The aims, structure, and 3- and 6-month outcomes of the vEC are detailed elsewhere.4,5 In this study, we present the glycemic metrics 9 months after the vEC. Nineteen Italian pediatric diabetes centers participated in this IRB-approved prospective multicenter clinical study.4,5 Children (6–17 years) who had already used the Basal-IQ system for at least 3 months with the carbohydrate counting system and were available to test Control-IQ and share their data on data-syncing software were enrolled and actively participated in the vEC.4 Each patient was then followed up by their own center every 3 months. If needed, teleconsultation and televisits were offered. The main study outcomes are as shown in Table 1. The 43 participants were aged 7–16 years (median 12, interquartile range [IQR] 9–13), of whom 53.5% were female. The duration of diabetes ranged from 2 to 13 years (median 6; IQR 4–9). The median body mass index z-score was −0.2 (IQR −0.6 to 0.2), and 19 (45%) participants were prepubertal according to Tanner's classification