Type of publication:

Conference abstract

Author(s):

*Jones A.; *Basavaraju N.; *Cane C.; *Moulik P.

Citation:

Diabetes Technology and Therapeutics. Conference: Advanced Techologies and Treatments for Diabetes Conference, ATTD 2024. Virtual. 26(Supplement 2) (pp A275-A276), 2024. Date of Publication: 01 Feb 2024.

Abstract:

Background and Aims: Hybrid closed loop(HCL) continuous subcutaneous insulin infusion(CSII) and continuous glucose monitoring(CGM) have made significant improvements in management of T1D.We studied benefits of Hybrid closed loop(HCL) over non-closed loop(NCL) CSII in a cohort of adults with T1D. Method(s): We analysed a live database of patients managed in a single District General Hospital (DGH) service on CSII from 2011 onwards. %Time in range (TIR), %hypoglycaemia (%hypo) and HbA1c were analysed with independent samples T-Test (SPSS software). Result(s): 302 patients were included: mean age was 44 years (range 19-81), female:male 57:43, diabetes duration 25years (range 2-61), and mean pre-CSII HbA1c 63mmol/mol. 218 were on HCL, 21 partial closed loop(PCL) and 63 were NCL. All patients were either on real-time(rt)CGM or intermittently scanned( is)CGM. HCL users were on Medtronic 780G with Guardian G4 sensor or Tandem T-Slim with Dexcom G6 sensor and NCL patients mostly on Omnipod DASH with rtCGM or isCGM. For HCL vs NCL systems, mean HbA1c (52 vs 57mmol/mol, p < 0.005), TIR (71% vs 62%, p < 0.005) were significantly improved on HCL. There was a trend to reduced %hypo (1.64% vs 2.64%,p = 0.08) but not statistically significant. Conclusion(s): This analysis demonstrates significantly better glycaemic control, in both HbA1c and TIR parameters, in HCL CSII users compared to NCL CSII in T1D. Hypoglycaemia was reduced but did not achieve statistical significance, possibly due to overall low rate of hypoglycaemia in the entire cohort. We speculate patients would have been responding to CGM alarm warnings to abort actual hypoglycaemic events.

Type of publication:

Conference abstract

Author(s):

*Jones A.; *Basavaraju N.; *Cane C.; *Kumar A.; *Moulik P.;

Citation:

Diabetes Technology and Therapeutics. Conference: Advanced Techologies and Treatments for Diabetes Conference, ATTD 2024. Virtual. 26(Supplement 2) (pp A230), 2024. Date of Publication: 01 Feb 2024.

Abstract:

Background and Aims: We assessed impact of CGM in existing CSII patients with T1D switching to hybrid closed loop (HCL), partial closed loop (PCL) or remaining on non-closed loop (NCL) CSII. Method(s): Outcomes of patients with T1D on CSII in an adult service from 2011 were reviewed. Analysis of %Time in range (%TIR), %hypoglycaemia (%hypo) and HbA1c was done with SPSS. Result(s): 302 patients were included. 183 were on Tandem T-Slim(T-Slim), 58 Omnipod Dash(DASH), 39 Medtronic780G(780G), 11 Medtronic670G(670G), and 7 Medtronic640G(640G). 218 were on HCL, 21 PCL and 63 NCL. All were on either real-time (rt)CGM (DexcomG6, GuardianG3 or GuardianG4) or intermittently scanned (is)CGM (Freestyle Libre2). T-Slim, DASH, 780G, 670G, 640G showed mean HbA1c of 53.8, 55.6, 53.0, 62, 52.8mmol/mol; %TIR of 70, 64, 72, 61, 56%; and %hypo of 1.7, 1.8, 2.0, 1.4, 4.0% respectively. Post-hoc analysis only showed statistically significant benefits with HbA1c for T-Slim over 670G, and 780G over 670G; %TIR for 780G over 640G and %hypo for T-Slim over 640G. Mean HbA1c and %TIR were significantly better on HCL vs NCL and PCL, but not %hypo. PCL did not show benefit over NCL in HbA1c, %TIR or %hypo. Conclusion(s): We propose CGM confers the most important interventional benefit in patients already on CSII. HCL provided additional benefits in improving glycaemia, both TIR and HbA1c, but not hypo in patients on CGM. PCL does not provide additional benefits over NCL in patients on CGM. QOL indices, however, may show additional benefits both in HCL and PCL.

Type of publication:

Conference abstract

Author(s):

*Jones A.; *Basavaraju N.; *Cane C.; *Kumar A.; *Moulik P.

Citation:

Diabetes Technology and Therapeutics. Conference: Advanced Techologies and Treatments for Diabetes Conference, ATTD 2024. Virtual. 26(Supplement 2) (pp A124), 2024. Date of Publication: 01 Feb 2024.

Abstract:

Background and Aims: There is a possibility of subconscious bias towards using complex technology in young adults. Patient perceptions towards treatment may be influenced by age. We explored outcomes and patient experiences in various age groups with Type 1 Diabetes(T1D). Method(s): Database of patients within a single adult pump service was analysed for HbA1c, %time in range(%TIR), %hypoglycaemia(%hypo). Additionally, for Hybrid closed-loop patients Diabetes Treatment Satisfaction Questionnaire (DTSQ), Type 1 Diabetes Distress score(T1DDS), Hypoglycaemia fear survey(HypoFS) and Insulin dosing systems, perceptions, ideas, reflections, and expectations (INSPIRE)scores were analysed in different age groups. Result(s): 302 patients were included: mean age 44 years (range 19-81), 57% females, mean diabetes duration 25years (range 2- 61), and mean pre-CSII HbA1c 63mmol/mol. 218 users had hybrid closed-loop(HCL), 21 partial closed-loop and 63 non-closed-loop CSII. All were on CGM. Only 2 patients were aged above 75years and excluded from statistical analysis. Compared to the entire cohort, 19-25-year-olds had worse mean HbA1c(53.8vs58.8%), TIR(68.7vs59%) and %hypo(1.79vs2.33%), of which only %hypo was not statistically significant. Clinical outcomes were similar in all other groups. Positive Correlation(r) with age was noted with TIR(r = 0.263,p <0.001), DTSQ(r = 0.143, p = 0.03), and negative correlation with %hypo(r = -0.127, p = 0.028), HypoFS(r = -0.309, p <0.001), T1DDS(r = -0.244,p <0.001), and INSPIRE(r = – 0.146,p = 0.038). HypoFS were worse in younger individuals with progressive improvement with increasing age. Conclusion(s): Young adults (19-25 years) had worse clinical outcomes compared to other adults on CSII. Diabetes distress, fear of hypoglycaemia was higher in younger individuals. Use of complex technology including HCL was equally embraced across all age groups, though younger patients may have greater acceptance.

Type of publication:

Conference abstract

Author(s):

*Basavaraju N.; *Jones A.; *Cane C.; *Moulik P.

Citation:

Diabetes Technology and Therapeutics. Conference: Advanced Techologies and Treatments for Diabetes Conference, ATTD 2024. Virtual. 26(Supplement 2) (pp A327), 2024. Date of Publication: 01 Feb 2024.

Abstract:

Background and Aims: Hybrid closed loop(HCL) continuous subcutaneous insulin infusion(CSII) and continuous glucose monitoring(CGM) have made significant improvements in management of T1D. We studied benefits of Hybrid closed loop(HCL) over non-closed loop(NCL) CSII in a cohort of adults with T1D. Method(s): We analysed a live database of patients managed in a single centre on CSII. Clinical parameters assessed included %Time in range(TIR), %hypoglycaemia(%hypo) and HbA1c. QOL was assessed with Diabetes Treatment Satisfaction Questionnaire( DTSQ), Hypoglycaemia Fear Survey(HFS), Type 1 Diabetes Distress score(T1DDS). Data was analysed using the SPSS software. Result(s): Data on 281 patients were included, mean age was 44 years(range 19-81), 57% females. 218 were on HCL (Medtronic 780G with Guardian G4 sensor or Tandem T-Slim with Dexcom G6 sensor) and 63 (Omnipod DASH with Dexcom G6 or Freestyle Libre 2). For HCL vs NCL systems, clinical parameters improved with mean HbA1c (52 vs 57mmol/mol, p < 0.005), TIR (71% vs 62%, p < 0.005) and %hypo (1.64% vs 2.64%, p = 0.08). QOL improvement favoured HCL, but were non-significant with mean DTSQ (36.3 vs 35.5, p = 0.21), HFS (33.6vs34.9, p = 0.71) and T1DDS (47.2 vs 49.3, p = 0.40). There was no significant difference in clinical or QOL parameters between Medtronic 780G and Tandem T-Slim HCL systems. Conclusion(s): HCL systems studied had clear benefits in terms of clinical outcome parameters compared to NCL, but this was not reflected in improved patient perceptions on QOL. All patients on NCL being on CGM may be a possible explanation, with the reassurance of CGM making the biggest impact on patients perceived QOL.

Type of publication:

Conference abstract

Author(s):

*Jones A.; *Basavaraju N.; *Cane C.; *Moulik P.

Citation:

Diabetes Technology and Therapeutics. Conference: Advanced Techologies and Treatments for Diabetes Conference, ATTD 2024. Virtual. 26(Supplement 2) (pp A326), 2024. Date of Publication: 01 Feb 2024.

Abstract:

Background and Aims: Patients with longstanding T1DM tend to have more glycaemic variability. Patient perceptions towards chronic disease change over time. We examined outcomes in patients on CSII with different DM durations. Method(s): A single adult service outcome database of T1DM patients was analysed for Hba1c, %Time in range(%TIR), %hypoglycaemia(%hypo). For Hybrid closed loop(HCL) patients, Diabetes Treatment satisfaction Questionnaire(DTSQ), Type 1 Diabetes Distress score(T1DDS), Hypoglycaemia fear survey(HypoFS) and Insulin dosing systems, perceptions, ideas, reflections and expectations(INSPIRE) scores were analysed. Results were compared across different disease duration groups. Result(s): A cohort of 302 patients with T1DM were studied. 218 were on HCL, 21 partial closed loop and 63 were nonclosed loop CSII. All were on CGM. Mean diabetes duration was 25 years (range 2-61), male:female 43:57. Mean Hba1c(53.8mmol/mol), %TIR(68.7%) and %hypo(1.79%) were similar except 21-30year duration group who had better Hba1c and TIR. Correlation(r) for Hba1c(r = -0.111,p = 0.055), TIR(r = 0.206, p < 0.001) and %hypo(r = -0.106, p = 0.067) suggest better outcomes with longer duration of diabetes. HypoFS(r = -0.169,p = 0.016) and T1DDS(r = -0.192,p = 0.006) scores correlated inversely, DTSQ(r = 0.148, p = 0.035) positively and INSPIRE(r = -0.127, p = 0.069) did not correlate with diabetes duration. Conclusion(s): CSII and CGM glycaemic outcomes were similar in patients with all diabetes durations, highest in the 20- 30 years duration group. Reasons for this remains uncertain. Longer duration correlated with better outcomes on Hba1c, TIR and satisfaction scores. Hypo fear and diabetes distress was greater with shorter duration though hypo frequency was not statistically correlated to diabetes duration. These may be due to human factors, better disease acceptance and perceptions with longer duration.

Type of publication:

Conference abstract

Author(s):

*Jones A.; *Basavaraju N.; *Cane C.; *Moulik P.

Citation:

Diabetes Technology and Therapeutics. Conference: Advanced Techologies and Treatments for Diabetes Conference, ATTD 2024. Virtual. 26(Supplement 2) (pp A326-A327), 2024. Date of Publication: 01 Feb 2024.

Abstract:

Background and Aims: There may be a bias towards use of expensive technological innovations in people from higher socioeconomic classes. We explored patient experiences and outcomes in different socioeconomic backgrounds with T1diabetes( T1DM) treated with insulin pumps. Method(s): Index of Multiple Deprivation (IMD), an official statistic based on income, education, employment, health, housing, crime and living environment was used to stratify patients into quintiles based on socioeconomic status. HbA1c, time in range(%TIR), %hypoglycaemia(%hypo), Diabetes Treatment Satisfaction Questionnaire (DTSQ), Type 1 Diabetes Distress score (T1DDS), Hypoglycaemia fear survey (HypoFS) and Insulin dosing systems, perceptions, ideas, reflections and expectations (INSPIRE) scores in different IMD quintiles were analysed. Result(s): 302 patients were included: mean age 44 years (range 19-81), male:female 43:57 diabetes duration 25years (range 2- 61). 218 were on hybrid closed-loop, 21 partial closed-loop and 63 on non-closed-loop CSII. All were on CGM. Mean HbA1c (53.7vs52.6mmol/mol, correlation r = -0.059,p = 0.3), %TIR (67.7vs70.1%,r = -0.053,p = 0.36) and %hypo (2.29vs1.58%,r = -0.117,p = 0.043) had a trend to be worse in lower socioeconomic classes but correlation was not statistically significant apart from in %hypo. Mean DTSQ and INSPIRE scores were similar between social classes but mean T1DDS (52.8vs41.8,r = -0.189,p = 0.007) and HypoFS (41.7vs29.9,r = -0.145,p = 0.038) scores were worse in lowest compared to highest social quintile. Conclusion(s): Outcomes on CSII and CGM were broadly similar across all social backgrounds. There was statistically significant correlation, albeit low, between lower socioeconomic class and hypoglycaemia. This may explain the higher greater diabetes distress and hypoglycaemia fear in lower socioeconomic classes. Diabetes treatment satisfaction including with HCL were similar.