학술논문
A Comparison of Postprandial Glucose Control in the Medtronic Advanced Hybrid Closed-Loop System Versus 670G.
Document Type
Journal Article
Author
Weinzimer, Stuart A.; Bailey, Ryan J.; Bergenstal, Richard M.; Nimri, Revital; Beck, Roy W.; Schatz, Desmond; Ambler-Osborn, Louise; Schweiger, Darja Smigoc; von dem Berge, Thekla; Sibayan, Judy; Johnson, Mary L. (NURSE); Calhoun, Peter; Phillip, Moshe; Criego, Amy; Carlson, Anders; Martens, Thomas; Beasley, Shannon; Whipple, Diane; Hyatt, Jamie; Punel, Alina
Source
Subject
*BLOOD sugar analysis
*INSULIN therapy
*HYPERGLYCEMIA prevention
*RESEARCH
*BLOOD sugar monitoring
*RESEARCH methodology
*TYPE 1 diabetes
*HYPOGLYCEMIC agents
*EVALUATION research
*COMPARATIVE studies
*RANDOMIZED controlled trials
*INSULIN pumps
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Language
ISSN
1520-9156
Abstract
Background: We recently reported that use of an "advanced" hybrid closed-loop system reduced hyperglycemia without increasing hypoglycemia compared to a first-generation system. The aim of this analysis was to evaluate whether this improved performance was specifically related to better mealtime glycemic control. Methods: We conducted a secondary analysis of postprandial glycemic control in an open-label, multinational, randomized crossover trial of 112 participants with type 1 diabetes, aged 14-29, of the Medtronic MiniMed™ 670G hybrid closed-loop system (670G) versus the Medtronic advanced hybrid closed-loop (AHCL) system, for 12 weeks each. We compared glycemic and insulin delivery metrics over a 3 h horizon across all meals to assess system performance and outcomes. Results: Overall meal size and premeal insulin on board were similar during run-in and between 670G and AHCL arms. Compared with 670G arm, premeal, peak, and mean glucose levels were numerically lower in the AHCL arm (167 ± 23, 231 ± 23, and 177 ± 20 mg/dL vs. 175 ± 23, 235 ± 23, and 180 ± 19 mg/dL, respectively), with a trend to lower hyperglycemia level 2 in AHCL arm. Adjusting for premeal glucose level, all postmeal outcomes between 670G and AHCL were statistically similar. Prandial insulin delivery also was similar in both treatment arms (21 ± 9 vs. 23 ± 10 U), with a shift in basal/bolus ratio from 28%/71% in 670G arm to 20%/80% in AHCL arm. Conclusions: Reduced hyperglycemia with AHCL compared to 670G was not related to early postprandial glycemic excursions after adjusting for premeal glucose level (<3 h after meal), but likely to later (>3 h) postprandial or overnight improvements. Further refinements to mealtime bolus algorithms and strategies may more optimally control prandial glycemic excursions. [ABSTRACT FROM AUTHOR]