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根据青春期状态的美敦力780G高级混合闭环系统治疗效果:卓越研究组的真实生活体验

MiniMed 780G Advanced Hybrid Closed-Loop System Outcomes According to Pubertal Status: Awesome Study Group Real-Life Experience.

作者信息

Rachmiel Marianna, Lebenthal Yael, Mazor-Aronovitch Kineret, Brener Avivit, Levek Noah, Jacobi-Polishook Talia, Ben Ari Tal, Abiri Shirli, Landau Zohar, Pinhas-Hamiel Orit

机构信息

Pediatric Endocrinology Unit, Shamir (Assaf Harofeh) Medical Center, Beer Yaakov, Israel.

Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

出版信息

Diabetes Technol Ther. 2023 Sep;25(9):643-651. doi: 10.1089/dia.2023.0081. Epub 2023 Jun 14.

Abstract

Achieving good glycemic control is a major challenge for adolescents with type 1 diabetes (TID). The introduction of the MiniMed 780G system, an advanced hybrid closed-loop (AHCL) that enables an automatic correction of insulin, gave hope for improved glycemic outcomes in adolescents. We assessed specific characteristics associated with glycemic measures in youth with T1D switching to Minimed 780G. This retrospective observational real-life multicenter study from the AWeSoMe Group assessed continuous glucose monitoring (CGM) metrics of 22 patients (59% females, median age 13.9 interquartile range [IQR 11,18] years), from a high socioeconomic background. CGM metrics were recorded for 2-week periods before AHCL, after 1, 3, 6 months, and at the end of follow-up (median 10.9 [IQR 5.4, 17.4] months). Delta-variables (Δ) were calculated as the difference between the end of follow-up and baseline. Time in range (TIR) increased from 65% [52, 72] to 75% [63, 80],  = 0.008, from baseline to end of follow-up. Time above range decreased from 28% [20, 46] to 22% [14, 35],  = 0.047. Advanced pubertal stage was correlated with less improvement in ΔTAR,  = 0.47,  = 0.05, and less CGM usage  = -0.57,  = 0.05. A longer disease duration was associated with less improvement in ΔTAR,  = 0.48,  = 0.05. Lower pump site change frequency was associated with higher glucose management indicator,  = 0.5,  = 0.03, and lower TIR  = -0.52,  = 0.08. The use of AHCL enabled improvements in TIR in youth with T1D. More advanced pubertal stages, longer disease duration, and less compliance were associated with less improvement, stressing the need for continuous support, and re-education in this age group.

摘要

对于1型糖尿病(TID)青少年而言,实现良好的血糖控制是一项重大挑战。MiniMed 780G系统的推出,这是一种能够自动校正胰岛素的先进混合闭环(AHCL)系统,为改善青少年的血糖结果带来了希望。我们评估了T1D青少年转换至MiniMed 780G后与血糖测量相关的特定特征。这项来自AWeSoMe小组的回顾性观察性现实生活多中心研究评估了22名患者(59%为女性,中位年龄13.9岁,四分位间距[IQR 11,18]岁)的连续血糖监测(CGM)指标,这些患者具有较高的社会经济背景。在AHCL之前、1个月、3个月、6个月以及随访结束时(中位时间10.9[IQR 5.4, 17.4]个月)的2周期间记录CGM指标。计算δ变量(Δ)作为随访结束与基线之间的差值。血糖达标时间(TIR)从基线到随访结束时从65%[52, 72]增加到75%[63, 80],P = 0.008。血糖高于目标范围的时间从28%[20, 46]下降到22%[14, 35],P = 0.047。青春期发育晚期与ΔTAR改善较少相关,P = 0.47,P = 0.05,且CGM使用较少,P = -0.57,P = 0.05。疾病持续时间较长与ΔTAR改善较少相关,P = 0.48,P = 0.05。较低的泵植入部位更换频率与较高的血糖管理指标相关,P = 0.5,P = 0.03,且TIR较低,P = -0.52,P = 0.08。使用AHCL可使T1D青少年的TIR得到改善。青春期发育阶段越高级、疾病持续时间越长以及依从性越低与改善越少相关,这凸显了该年龄组持续支持和再教育的必要性。

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