Introduction: Advanced Hybrid Closed Loop (aHCL) systems have revolutionized the management of type 1 diabetes (T1D) by improving glycemic control. However, long-term follow-up data in pediatric populations are still limited. Objectives: To evaluate the 36-month efficacy of aHCL system Medtronic Minimed 780G on HbA1c in a cohort of children and adolescents with T1D. Methods: All consecutive individuals with T1D and aged <18 years at aHCL initiation were enrolled. Outcomes included HbA1c and continuous glucose monitoring (CGM) metrics. Statistical analyses were performed using repeated measures ANOVA or Friedman’s test, followed by Bonferroni-corrected t-test or Dunn’s test for pairwise multiple comparisons, respectively. Results: Thirty-six patients (mean age at aHCL start 11.3±5.4 years; 22% <7 years; 55.5% female) were retrospectively analyzed. HbA1c significantly improved from 8.08% at baseline to 7.5% at 12 months, 7.3% at 24 months, and 7.0% at 36 months (p<0.001), with significant improvements evident as early as 12 months. In a stratified analysis, patients achieving HbA1c <7% at 36 months (42%) showed a more stable and pronounced HbA1c improvement (6.9% at 12 months, 7.0% at 24 months, 6.6% at 36 months; p<0.001) compared to those with HbA1c ≥7% (58%; 7.7% at 12 months, 7.6% at 24 months, 7.4% at 36 months), despite similar baseline HbA1c levels (7.8% vs. 8.1%). Patients who initiated aHCL before 7 years of age achieved the HbA1c goal of <7% more frequently (63%) compared to subjects aged 7 to 14 years (44%), and above 14 years of age (25%), although the differences were not statistically significant. No significant differences were observed in CGM sensor performance metrics between groups. Conclusions: aHCL therapy with Medtronic Minimed 780G provides sustained HbA1c improvement over 36 months in pediatric patients with T1D without increasing the risk of hypoglycemia. Further studies are needed to identify predictors of optimal long-term response.
Long-term glycemic outcomes in children and adolescents with type 1 diabetes on advanced Hybrid Closed Loop therapy with Medtronic Minimed 780G: a 36-month follow-up
E. Catamo;A. Robino;C. Carletti;A. Fachin;G. Tamaro;G. Tornese
2025-01-01
Abstract
Introduction: Advanced Hybrid Closed Loop (aHCL) systems have revolutionized the management of type 1 diabetes (T1D) by improving glycemic control. However, long-term follow-up data in pediatric populations are still limited. Objectives: To evaluate the 36-month efficacy of aHCL system Medtronic Minimed 780G on HbA1c in a cohort of children and adolescents with T1D. Methods: All consecutive individuals with T1D and aged <18 years at aHCL initiation were enrolled. Outcomes included HbA1c and continuous glucose monitoring (CGM) metrics. Statistical analyses were performed using repeated measures ANOVA or Friedman’s test, followed by Bonferroni-corrected t-test or Dunn’s test for pairwise multiple comparisons, respectively. Results: Thirty-six patients (mean age at aHCL start 11.3±5.4 years; 22% <7 years; 55.5% female) were retrospectively analyzed. HbA1c significantly improved from 8.08% at baseline to 7.5% at 12 months, 7.3% at 24 months, and 7.0% at 36 months (p<0.001), with significant improvements evident as early as 12 months. In a stratified analysis, patients achieving HbA1c <7% at 36 months (42%) showed a more stable and pronounced HbA1c improvement (6.9% at 12 months, 7.0% at 24 months, 6.6% at 36 months; p<0.001) compared to those with HbA1c ≥7% (58%; 7.7% at 12 months, 7.6% at 24 months, 7.4% at 36 months), despite similar baseline HbA1c levels (7.8% vs. 8.1%). Patients who initiated aHCL before 7 years of age achieved the HbA1c goal of <7% more frequently (63%) compared to subjects aged 7 to 14 years (44%), and above 14 years of age (25%), although the differences were not statistically significant. No significant differences were observed in CGM sensor performance metrics between groups. Conclusions: aHCL therapy with Medtronic Minimed 780G provides sustained HbA1c improvement over 36 months in pediatric patients with T1D without increasing the risk of hypoglycemia. Further studies are needed to identify predictors of optimal long-term response.Pubblicazioni consigliate
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