Endocr Pract. 2019 May;25(5):477-484. doi: 10.4158/EP-2018-0515. Epub 2019 Mar 13.
Clinical trial data demonstrates improved glycemic control with hybrid close loop (HCL) insulin delivery systems, yet limited real-world data exists. Data from the inaugural cohort of patients initiating a HCL system (Medtronic MiniMed 670G, Medtronic Canada, Brampton, ON) at a university medical center was used to examine real-world utilization and glycemic control following a standardized implementation process. Data from 34 adult patients with type 1 diabetes were obtained from pump downloads at 4 time points: () previous insulin pump, () HCL in manual-mode, () 2 weeks after HCL auto-mode transition, and () 6 to 12 weeks after initiation of HCL. In-person training by certified diabetes educators was performed across 3 sessions with phone and electronic messaging following auto-mode start. Mean self-monitored blood glucose (SMBG) per day increased from 5.15 baseline to 6.49 at 6 to 12 weeks (<.05) with 3.26 sensor calibrations per day. Time-in-auto-mode was 79.3% at 2 weeks and 72.3% at final follow-up, with 82% of patients spending >50% of time in auto-mode. There were 8.2 auto-mode exits over the final 14-day download. Time-in-target was 67.3% in manual-mode, 73.4% at 2 weeks ( = .09), and 71.7% by 6 to 12 weeks ( = .06). Hemoglobin A1c (HbA1c) decreased by 0.51% ( = .02), while total daily dose and % basal did not change. Patients with HbA1c <7.0% (53 mmol/mol) at baseline spent more time-in-target than those with HbA1c ≥7.0% (53 mmol/mol; 78.0% versus 67.5%) despite spending less time-in-auto-mode (66.5% versus 74.8%). These data illustrate real-world implementation of HCL technology using a structured education program within a major medical center. Overall benefit may vary based on baseline characteristics such as HbA1c. = certified diabetes educator; = hemoglobin A1c; = hybrid closed loop; = self-monitored blood glucose.
临床试验数据表明，混合闭环（HCL）胰岛素输送系统可改善血糖控制，但实际数据有限。使用大学医疗中心首例开始使用 HCL 系统（美敦力 MiniMed 670G，美敦力加拿大，布兰普顿，ON）的患者队列的数据，检查标准化实施流程后的实际使用情况和血糖控制。从 34 名 1 型糖尿病成年患者的胰岛素泵下载中获得了 4 个时间点的数据：（）之前的胰岛素泵，（）手动模式下的 HCL，（）HCL 自动模式转换后的 2 周，（）HCL 启动后 6 至 12 周。认证的糖尿病教育者通过 3 次会议进行了面对面培训，并在自动模式开始后通过电话和电子消息进行了跟进。自我监测血糖（SMBG）的平均每日值从基线的 5.15 增加到 6 至 12 周时的 6.49（<.05），每日传感器校准 3.26 次。2 周时自动模式时间为 79.3%，最终随访时为 72.3%，82%的患者自动模式时间>50%。在最后 14 天的下载中，自动模式退出了 8.2 次。手动模式下的时间目标为 67.3%，2 周时为 73.4%（=.09），6 至 12 周时为 71.7%（=.06）。糖化血红蛋白（HbA1c）下降了 0.51%（=.02），而总日剂量和%基础不变。基线时 HbA1c<7.0%（53 mmol/mol）的患者时间目标内的时间多于 HbA1c≥7.0%（53 mmol/mol；78.0%比 67.5%），尽管他们的自动模式时间更短（66.5%比 74.8%）。这些数据说明了在大型医疗中心内使用结构化教育计划在现实世界中实施 HCL 技术的情况。整体益处可能因基线特征（如 HbA1c）而异。=认证的糖尿病教育者；=血红蛋白 A1c；=混合闭环；=自我监测血糖。
