Gómez Medina Ana María, Henao Carrillo Diana Cristina, Silva León Julio David, Gómez González Javier Alberto, Muñoz Velandia Oscar Mauricio, Conde Brahim Lucia, Mecón Prada Guillermo Andrés, Rondón Sepúlveda Martin
Endocrinology Unit, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia.
Department of Internal Medicine, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia.
J Diabetes Sci Technol. 2025 May;19(3):778-786. doi: 10.1177/19322968231204376. Epub 2023 Nov 9.
Evidence regarding the implementation of medium-term strategies in advanced hybrid closed-loop (AHCL) system users is limited. Therefore, this study aimed to describe the efficacy and safety of the AHCL system in patients with type 1 diabetes (T1D) on a six-month follow-up in a virtual diabetes clinic (VDC).
A prospective cohort of adult patients with T1D treated using the AHCL system (Mini Med 780G; Medtronic, Northridge, California) in a VDC follow-up. Standardized training and follow-up were conducted virtually. Clinical data and metabolic control outcomes were reported at baseline, and at three and six months.
Sixty-four patients (mean age = 42 ± 14.6 years, 65% men, 54% with graduate education) were included. Percentage time in range (%TIR) increased significantly regardless of prior therapy with intermittently scanned continuous glucose monitoring + multiple daily injections and sensor-augmented pump therapy with predictive low-glucose management after starting AHCL and persisted during the follow-up period with no hypoglycemic events. The %TIR 70 to 180 mg/dL according to socioeconomic strata was 73.4% ± 5.3%, 78.1% ± 8.1%, and 84.2% ± 7.5% for the lower, middle, and upper strata, respectively. The sensor was used more frequently in the population with a higher education level. Adherence to sensor use and SmartGuard retention were higher in patients who underwent the VDC follow-up.
Medium-term follow-up of users of AHCL systems in a VDC contributes to safely achieving %TIR goals. Virtual diabetes clinic follow-up favored adherence to sensor use and continuous SmartGuard use. Socioeconomic strata were associated with a better glycemic profile and education level was associated with better adherence to sensor use.
关于在先进混合闭环（AHCL）系统使用者中实施中期策略的证据有限。因此，本研究旨在描述AHCL系统在1型糖尿病（T1D）患者中，于虚拟糖尿病诊所（VDC）进行六个月随访时的疗效和安全性。
对在VDC随访中使用AHCL系统（美敦力780G；美敦力公司，加利福尼亚州北岭）治疗的成年T1D患者进行前瞻性队列研究。通过虚拟方式进行标准化培训和随访。在基线、三个月和六个月时报告临床数据和代谢控制结果。
纳入64例患者（平均年龄 = 42 ± 14.6岁，65%为男性，54%具有研究生学历）。无论先前采用间歇性扫描式持续葡萄糖监测 + 每日多次注射治疗，还是采用带有预测性低血糖管理功能的传感器增强型泵治疗，开始使用AHCL系统后，血糖在目标范围内的时间百分比（%TIR）均显著增加，且在随访期间持续保持，无低血糖事件发生。根据社会经济阶层划分，血糖水平在70至180 mg/dL的%TIR，下层、中层和上层分别为73.4% ± 5.3%、78.1% ± 8.1%和84.2% ± 7.5%。传感器在高等教育水平人群中使用更为频繁。接受VDC随访的患者对传感器使用的依从性和SmartGuard保留率更高。
在VDC中对AHCL系统使用者进行中期随访有助于安全实现%TIR目标。虚拟糖尿病诊所随访有利于提高对传感器使用的依从性和持续使用SmartGuard。社会经济阶层与更好的血糖状况相关，教育水平与更好的传感器使用依从性相关。
