Significant Improvement in Glycemic Control after Initiation of AHCL in Children with Type 1 Diabetes: A Single Center Prospective Study

Objective: This study aims to investigate the early impact of advanced hybrid closed loop system (AHCL) in achieving and maintaining treatment goals in children with T1D. Materials and methods: A prospective longitudinal study was designed. Two separate analyzes were performed. The first one included the comparison of two systems in children with T1D who used to have Medtronic 640G system, then upgraded to the AHCL system, while the second analysis included the first 3 month-period analysis of glycemic parameters of children using AHCL, regardless their previous treatment before AHCL. Change in time in range (TIR) and a glucose management indicator (GMI) were compared at 3-month from baseline using t-test and Mann-Whitney U-test based on normality of the data. Results: The cohort-1 included the children (n = 25, age: 10.5 ± 2.5 years) who were transitioned from Medtronic 640G to AHCL. TIR (3.8–10 mmol/L) increased from 75.5 ± 10% at baseline to 80 ± 6.2% at 3 months (p = 0.008). The cohort-2 included 33 children (age: 12.1 ± 3.2 years) and a total of 2970 patient-days were analyzed. The mean TIR (3.8–10 mmol/L), was 79.8 ± 8.1%. The mean GMI was 6.6 ± 0.3%. The frequency of participants who had a GMI < 7%, time below range (TBR < 3.8 mmol/L) < 4% were 84.8% and 100%, respectively. The fraction of those who achieved the 3 glycemic targets (GMI < 7% and TIR > 70% and TBR < 4%) was 81.8%. Conclusions: This is the first study to report the positive impact of AHCL on the glycemic metrics of children with T1D from Turkey. Almost all children using AHCL have achieved glycemic targets and it is possible to achieve percentage of TIR which exceeds 80% with this system

“My Friend Diabetes Carbohydrate-Bolus Calculator”: User Experiences of a Bolus Calculating Carbohydrate Counting Mobile App for People with Type 1 Diabetes

Objective: Meal management in Type 1 Diabetes (T1D) has barriers such as miscalculation of doses, insufficient carbohydrate counting and numeracy skills. “My Friend Diabetes Carbohydrate Bolus Calculator” mobile app was developed as a hybrid version of nutrition apps and insulin titration apps to calculate meal’s carbs and the matching bolus dose. This study investigates facilitator role of the app on lives of people with T1D. Materials and methods: People with T1D or their caregivers were recruited from children diabetes foundation social media accounts, and they answered an online survey which examines the effects of the app on carbohydrate counting, diabetes management, and the usability of the app with 17 Likert-type questions (5-point). Descriptive and non-parametric tests were performed to analyze responses. Results: Of the 165 people who completed the survey, 58 (35.2%) had T1D, 107 (64.8%) had relatives with T1D; 87 (52.7%) participants were female, the mean age was 13.1 ± 8.9 years, and the mean duration of diabetes was 4.72 years. Of the participants, 130 used the app and agreed that the app improved the users’ meal management, diabetes management, carbohydrate, and dose calculations (Mean score = 4.38 ± 0.57). They were more confident in the dose calculation, freer in the food choices, and more confident in diabetes care because of the app (Mean score = 4.46 ± 0.57). Conclusions: ‘’My Friend Diabetes Carbohydrate-Bolus Calculator’’ mobile app improved T1D management. Diabetes teams can reach more people through mobile apps and improve their clinical outcomes

Free-living use of artificial pancreas for children with type 1 diabetes: systematic review

BACKGRAUND: A closed-loop glucose control system or artificial pancreas consists of three components a Continuous Glucose Monitor (CGM), infusion pumps to deliver hormone(s) and a sophisticated dosing algorithm to control hormone delivery. In the past years, numerous studies with closed-loop system devices were conducted with gradual shift to out-of-hospital environment and with lengthening study duration. AIMS: To compare efficacy and safety of closed-loop insulin pump use in children with type 1 diabetes mellitus in compare with conventional insulin treatment (continuous subcutaneous insulin infusion (CSII) with our without CGM) based on randomized control trials data (RCT). METHODS: In the systematic review we have include 28 randomized controlled trials results indexed in PubMed, Medline databases published till 15 June 2017. The efficacy on metabolic control in this study evaluated by the proportion of time within target range (preferably 70 to 180 mg/dl if reported) and mean (median) glucose based on sensor measurements, and the safety evaluated by time in hypoglycemia (below 70 mg/dl if reported). RESULTS: Increased time in range in the night period was observed in all RCT. Only 3 RCT showed decrease of the time in range within 24 h evaluation period. In one RCT the significant positive differences have been shown in the time in range for dual hormone closed-loop glucose control system in compare with insulin-only artificial pancreas. Mean glycaemia and glucose variability changes were not in the same manner in different RCT, both in the night only and in 24 h estimation period. Night hypoglycemia duration decreased in most RCT with closed-loop control in compare with CSII, and increased only in 2 RCT. When all-day estimation period the time in hypoglycemia changed not in the same manner in different RCT. Valuable methodology differences of the glycaemic control estimation within observed RCT brought significant complications in the data analysis and made impossible the results quantitative estimation to prepare a metaanalysis. CONCLUSIONS: Much work has been done to develop effective and safe artificial pancreas, but not all RCTs confirmed advantages of closed-loop glucose control in compare with CSII in children and adolescents in real life. More research with prospective randomized control design required to prove benefits of closed-loop glucose control. Further RCTs should have an uniform methodology for glycemic control assessment and long duration that will allow to use cumulative measures in a closed-loop efficacy estimation (HbA1c)