Department of Endocrinology, Xixi Hospital of Hangzhou (Affiliated Hangzhou Xixi Hospital of Zhejiang Chinese Medical University), Hangzhou, Zhejiang Province, Hangzhou, China.
Department of Anesthesiology, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital, Hangzhou First People's Hospital Qianjiang New City Campus, Zhejiang Chinese Medical University), Hangzhou, China.
PLoS One. 2024 Aug 12;19(8):e0308202. doi: 10.1371/journal.pone.0308202. eCollection 2024.
Longer outpatient studies have demonstrated that hybrid closed loop (HCL) use has led to a concomitant reduction in glycated hemoglobin(HbA1c) by 0.3%-0.7%. However, reports have also indicated that HbA1c levels are not declined in the long-term use of HCL. Therefore, we wonder that 3 months use of HCL could improve glycated hemoglobin levels in adolescents and children with T1D.
Relevant studies were searched electronically in the Cochrane Library, PubMed, and Embase utilizing the key words "Pediatrics or Child or Adolescent", "Insulin Infusion Systems" and "Diabetes Mellitus" from inception to 17th March 2024 to evaluate the performance of HCL on HbA1c in adolescents, and children with T1D.
Nine studies involving 927 patients were identified. Three months use of HCL show a beneficial effect on HbA1c management (p <0.001) as compared to standard of care in adolescents and children with T1D, without evidence of heterogeneity between articles (I2 = 40%, p = 0.10). HCL did significantly increase the overall average percentage of hypoglycemic time between 70 and 180 mg/dL (TIR) (p <0.001; I2 = 51%). HCL did not show a beneficial effect on hypoglycemic time <70 mg/dL and <54 mg/dL (p >0.05). The overall percentage of hyperglycemic time was significantly decreased in HCL group compared to the control group when it was defined as >180 mg/dL (p <0.001; I2 = 83%), >250 mg/dL (p = 0.007, I2 = 86%) and >300 mg/dL (p = 0.005; I2 = 76%). The mean glucose level was significantly decreased by HCL (p <0.001; I2 = 58%), however, no significant difference was found in coefficient of variation of sensor glucose (p = 0.82; I2 = 71%) and daily insulin dose (p = 0.94; I2 <0.001) between the HCL group and the control group.
HCL had a beneficial effect on HbA1c management and TIR without increased hypoglycemic time as compared to standard of care in adolescents and children with T1D when therapy duration of HCL was not less than three months.
CRD42022367493; https://www.crd.york.ac.uk/PROSPERO, Principal investigator: Zhen-feng Zhou, Date of registration: October 30, 2022.
更长时间的门诊研究表明，混合闭环（HCL）的使用导致糖化血红蛋白（HbA1c）降低 0.3%-0.7%。然而，也有报道称 HCL 的长期使用并没有降低 HbA1c 水平。因此，我们想知道 HCL 的 3 个月使用是否可以改善 T1D 青少年和儿童的糖化血红蛋白水平。
我们在 Cochrane 图书馆、PubMed 和 Embase 中使用“儿科或儿童或青少年”、“胰岛素输注系统”和“糖尿病”等关键词，从成立到 2024 年 3 月 17 日进行电子搜索，以评估 HCL 在 T1D 青少年和儿童中的 HbA1c 表现。
确定了 9 项涉及 927 名患者的研究。与 T1D 青少年和儿童的标准护理相比，HCL 使用 3 个月对 HbA1c 管理有有益影响（p<0.001），文章之间没有异质性（I2=40%，p=0.10）。HCL 显著增加了 70-180mg/dL（TIR）之间的总体平均低血糖时间百分比（p<0.001；I2=51%）。HCL 对<70mg/dL 和<54mg/dL 的低血糖时间没有有益影响（p>0.05）。与对照组相比，HCL 组的高血糖时间总体百分比显著降低，定义为>180mg/dL（p<0.001；I2=83%）、>250mg/dL（p=0.007，I2=86%）和>300mg/dL（p=0.005；I2=76%）。HCL 显著降低了平均血糖水平（p<0.001；I2=58%），但 HCL 组与对照组之间的传感器葡萄糖变异系数（p=0.82；I2=71%）和每日胰岛素剂量（p=0.94；I2<0.001）无显著差异。
与 T1D 青少年和儿童的标准护理相比，HCL 的使用时间不少于 3 个月时，HbA1c 管理和 TIR 有有益影响，且低血糖时间无增加。
CRD42022367493；https://www.crd.york.ac.uk/PROSPERO，主要研究者：Zhen-feng Zhou，注册日期：2022 年 10 月 30 日。
