Oral Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2016

A Comparison of Glycaemic Control in Adults and Adolescents With Type 1 Diabetes When Using a Closed Loop Insulin Delivery System Overnight Versus Sensor-Augmented Pump With Low Glucose Suspend At Home: A Randomised Crossover Study (#159)

Amin Sharifi 1 , MARTIN DE BOCK 2 , DILSHANI JAYAWARDENE 1 , MARGARET LOH 1 , JODIE HORSBURGH 1 , CAROLYN BERTHOLD 2 , NIRUBASINI PARAMALINGAM 2 , Alicia Jenkins 3 , Kavita Kumareswaran 4 , Jane Speight 5 , Christel Hendrieckx 5 , Richard MacIsaac 1 , Glenn Ward 1 , Peter Colman 6 , Leon Bach 4 , ANDREW KYOONG 7 , Liz Davis 2 , NATALIE KURTZ 8 , BENYAMIN GROSMAN 8 , ANIRBAN ROY 8 , Tim Jones 8 , David O'Neal 1
  1. Department Of Endocrinology and Diabetes, St Vincent's Hospital, Melbourne, VIC, Australia
  2. Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Subiaco, WA, Australia
  3. Department of Medicine, University of Sydney, Sydney, NSW, Australia
  4. Department of Endocrinology and Diabetes, The Alfred, Prahran, VIC, AUSTRALIA
  5. The Australian Centre for Behavioural Research in Diabetes, Deakin University, Burwood, VIC, AUSTRALIA
  6. Department of Endocrinology and Diabetes, Royal Melbourne Hospital, Parkville, VIC, Australia
  7. Department of Respiratory and Sleep Medicine, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
  8. Medtronic MiniMed, Northridge, CA, USA

BACKGROUND: We compared glycaemic control with home use of night-time Android-based hybrid closed loop system (Android-HCLS) with sensor-augmented pump with low glucose suspend (SAP-LGS) in people with type 1 diabetes.

METHODS: An open-label, prospective, randomised, crossover study of 16 adults (mean [SD] age 42·1 [9·6] years) and 12 adolescents (15·2 [1·6] years) with type 1 diabetes was conducted. Randomisation was computer-generated, and allocation concealed until run-in completion. All participants completed four nights at home with Android-HCLS (proportional integral derivative with insulin feedback algorithm; Medtronic) and SAP-LGS. Primary outcome: percent continuous glucose monitoring (CGM) time (00:00-08:00hrs) within target range (4-8mmol/L). Secondary endpoints: percent CGM time above target (>8mmol/L); below target (<4mmol/L); glycaemic variability (SD) and symptomatic hypoglycaemia.

RESULTS: Using Android-HCLS, compared with SAP-LGS, adults had greater mean[SD] percent time within target range (57·7[18·6]% vs 44·5[14·5]%; p<0·006); less time above target (42·0[18·7]% vs 52·6[16·5]%; p=0·034); lower glycaemic variability (1·9[0·6] vs 2·6[0·6]; p=0·003) and less (median[IQR]) time below target (0·0[0·0, 0·4]% vs 0·80[0·0,3·9]%; p=0·025). In adolescents, time below target was lower with Android-HCLS vs SAP-LGS(0·0[0·0,0·0]% vs 1·8[0·1,7·9]%; p=0·011). Symptomatic hypoglycaemia was less (1 vs 10; p=0·007) in adolescents but not adults (5 vs 13; p=0·059).

CONCLUSIONS: Android-HCLS in both adults and adolescents reduced nocturnal hypoglycaemia and in adults improved overnight time in target range and treatment satisfaction compared with best contemporary treatment.