Type 1 Diabetes Technology Gets Patients Closer to Targets

Previously Published on Medscape.com – The odds of a person with type 1 diabetes achieving target A1c levels and avoiding severe hypoglycemia increase with greater degrees of automation in the technology they’re using, new real-world data show.

Most notably, the likelihood of experiencing a severe hypoglycemic episode in the prior year was more than double for those taking multiple daily injections (MDI) of CGM seems to add that extra jump without use of a continuous glucose monitor (CGM) compared with those using hybrid closed-loop automated insulin delivery, also known as artificial pancreas systems.

“It seems that with each incremental increase in technology you see a decrease in A1c. CGM seems to add that extra jump,” said Kellee M. Miller, PhD, MPH, who presented the findings from the T1D Exchange registry at the American Diabetes Association (ADA) 82nd Scientific Sessions.

A “High Tech Savvy” Cohort

Miller noted that the more than 17,000 CGM seems to add that extra jump participants are “not representative of the general population. It’s obviously a very high-tech savvy cohort but it does provide insight into outcomes outside of a clinical study setting.”

“Observations from the T1D Exchange patient registry support findings of clinical trials showing glycemic benefit with hybrid-closed loop [artificial pancreas] use,” added Miller, director of research & senior epidemiologist at the Jaeb Center for Health Research, Tampa, Florida.

When asked to comment, the initial response of session moderator Diana Isaacs, PharmD, CDCES, of the Cleveland Clinic, Ohio. She said, “Wow, we can’t let people be on MDI without CGM. That is really scary.”

Isaacs said the overall data suggest that “clearly [insulin] pump plus CGM and having the connected technology…is superior…compared to MDI, and even MDI plus CGM. So we have to be sure we’re offering it to everyone. Otherwise there will be much worse outcomes later in life, given the A1c differences. We really need to work to close the gaps in disparities.”

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