Graf Sophie, Hofer Giulia, Hirschmann Ruth, Lehmann Roger, Cavelti-Weder Claudia
Department of Endocrinology Diabetology and Clinical Nutrition University Hospital Zurich (USZ) and University of Zurich (UZH) Zurich Switzerland.
Department of Endocrinology Diabetology and Clinical Nutrition University Hospital Zurich (USZ) and University of Zurich (UZH) Zurich Switzerland.
Diabetes Res Clin Pract. 2025 Apr;222:112035. doi: 10.1016/j.diabres.2025.112035. Epub 2025 Feb 8.
The advanced hybrid closed loop (a-HCL) algorithm includes automated basal and correction bolus insulin with customizable glucose targets. This study aimed to evaluate the effectiveness of a-HCL compared to predictive low glucose suspension (PLGS) and standard hybrid closed-loop (s-HCL) systems and to identify patient populations experiencing the greatest glycemic improvement after transitioning to a-HCL.
This retrospective study included type 1 diabetes patients at the University Hospital Zurich, Switzerland, who transitioned from PLGS or s-HCL to a-HCL between January 2020 and December 2021. Glycemic metrics, including HbA1c, time in range (TIR), time above range (TAR), time below range (TBR), sensor glucose (SG), and coefficient of variation (CV), were analyzed pre-and post-a-HCL implementation, considering clinical parameters influencing outcomes.
Among 71 patients, a-HCL implementation significantly reduced in HbA1c (7.2 ± 0.9 % to 6.8 ± 0.5 %, p < 0.001), SG (8.8 ± 1.4 mmol/L to 7.8 ± 0.8 mmol/L, p < 0.001), TAR (26.3 % to 17.3 %, p < 0.001) and increased TIR (68.5 % to 79.8 %, p < 0.001). TBR and CV showed no significant changes. Improvements were most pronounced in patients with higher baseline HbA1c, SG, CV and lower TIR, all indicators of poor glycemic control, and a BMI > 30 kg/m.
Our findings support a-HCL utilization across all patients, particularly in poorly controlled type 1 diabetes patients.
先进的混合闭环（a-HCL）算法包括可定制血糖目标的自动基础胰岛素和校正大剂量胰岛素。本研究旨在评估a-HCL与预测性低血糖暂停（PLGS）和标准混合闭环（s-HCL）系统相比的有效性，并确定转换至a-HCL后血糖改善最大的患者群体。
这项回顾性研究纳入了瑞士苏黎世大学医院的1型糖尿病患者，他们在2020年1月至2021年12月期间从PLGS或s-HCL转换至a-HCL。在实施a-HCL前后分析血糖指标，包括糖化血红蛋白（HbA1c）、血糖达标时间（TIR）、血糖高于目标范围时间（TAR）、血糖低于目标范围时间（TBR）、传感器葡萄糖（SG）和变异系数（CV），同时考虑影响结果的临床参数。
在71例患者中，实施a-HCL后糖化血红蛋白（从7.2±0.9%降至6.8±0.5%，p<0.001）、传感器葡萄糖（从8.8±1.4mmol/L降至7.8±0.8mmol/L，p<0.001）、血糖高于目标范围时间（从26.3%降至17.3%，p<0.001）显著降低，血糖达标时间增加（从68.5%增至79.8%，p<0.001）。血糖低于目标范围时间和变异系数无显著变化。在基线糖化血红蛋白、传感器葡萄糖、变异系数较高且血糖达标时间较低（均为血糖控制不佳的指标）以及体重指数>30kg/m²的患者中，改善最为明显。
我们的研究结果支持在所有患者中使用a-HCL，尤其是在血糖控制不佳的1型糖尿病患者中。
