학술논문
Predictors of Time-in-Range (70-180 mg/dL) Achieved Using a Closed-Loop Control System.
Document Type
Journal Article
Author
Schoelwer, Melissa J; Kanapka, Lauren G; Wadwa, R Paul; Breton, Marc D; Ruedy, Katrina J; Ekhlaspour, Laya; Forlenza, Gregory P; Cobry, Erin C; Messer, Laurel H; Cengiz, Eda; Jost, Emily; Carria, Lori; Emory, Emma; Hsu, Liana J; Weinzimer, Stuart A; Buckingham, Bruce A; Lal, Rayhan A; Oliveri, Mary Clancy; Kollman, Craig C; Dokken, Betsy B
Source
Subject
*CLOSED loop systems
*FORECASTING
*TYPE 1 diabetes
*GLYCEMIC control
*BODY weight
*INSULIN therapy
*RESEARCH
*BLOOD sugar monitoring
*RESEARCH methodology
*HYPOGLYCEMIC agents
*BLOOD sugar
*EVALUATION research
*COMPARATIVE studies
*INSULIN pumps
*RESEARCH funding
*
*
*
*
*
*
*
*
*
*
*
*
*
*
Language
ISSN
1520-9156
Abstract
Background: Studies of closed-loop control (CLC) in patients with type 1 diabetes (T1D) consistently demonstrate improvements in glycemic control as measured by increased time-in-range (TIR) 70-180 mg/dL. However, clinical predictors of TIR in users of CLC systems are needed. Materials and Methods: We analyzed data from 100 children aged 6-13 years with T1D using the Tandem Control-IQ CLC system during a randomized trial or subsequent extension phase. Continuous glucose monitor data were collected at baseline and during 12-16 weeks of CLC use. Participants were stratified into quartiles of TIR on CLC to compare clinical characteristics. Results: TIR for those in the first, second, third, and fourth quartiles was 54%, 65%, 71%, and 78%, respectively. Lower baseline TIR was associated with lower TIR on CLC (r = 0.69, P < 0.001). However, lower baseline TIR was also associated with greater improvement in TIR on CLC (r = -0.81, P < 0.001). During CLC, participants in the highest versus lowest TIR-quartile administered more user-initiated boluses daily (8.5 ± 2.8 vs. 5.8 ± 2.6, P < 0.001) and received fewer automated boluses (3.5 ± 1.0 vs. 6.0 ± 1.6, P < 0.001). Participants in the lowest (vs. the highest) TIR-quartile received more insulin per body weight (1.13 ± 0.27 vs. 0.87 ± 0.20 U/kg/d, P = 0.008). However, in a multivariate model adjusting for baseline TIR, user-initiated boluses and insulin-per-body-weight were no longer significant. Conclusions: Higher baseline TIR is the strongest predictor of TIR on CLC in children with T1D. However, lower baseline TIR is associated with the greatest improvement in TIR. As with open-loop systems, user engagement is important for optimal glycemic control. [ABSTRACT FROM AUTHOR]