Impact of Overnight Home Closed Loop (CL) Insulin Delivery on Glycaemic Control and Counter-Regulatory Hormones Compared to Sensor Augmented Pump Therapy with Low Glucose Suspend (SAP-LGS) in Patients with Type 1 Diabetes (T1D) — ASN Events
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  3. Impact of Overnight Home Closed Loop (CL) Insulin Delivery on Glycaemic Control and Counter-Regulatory Hormones Compared to Sensor Augmented Pump Therapy with Low Glucose Suspend (SAP-LGS) in Patients with Type 1 Diabetes (T1D)

Impact of Overnight Home Closed Loop (CL) Insulin Delivery on Glycaemic Control and Counter-Regulatory Hormones Compared to Sensor Augmented Pump Therapy with Low Glucose Suspend (SAP-LGS) in Patients with Type 1 Diabetes (T1D) (#89)

AMIN SHARIFI 1 , MARTIN DE BOCK 2 , JAYAWARDENE DILSHANI 1 , MARGARET LOH 1 , JODIE C HORSBURGH 3 , ALICIA J JENKINS 4 , KAVITA KUMARESWARAN 5 , JANE SPEIGHT 6 , CHRISTEL HENDRIECKX 6 , RICHARD J MACISAAC 1 , WARD M GLENN 1 , PETER G COLMAN 7 , LEON BACH 5 , ANDREW KYOONG 8 , NATALIE KURTZ 9 , ANIRBAN ROY 9 , TIMOTHY W JONES 10 , DAVID N O'NEAL 1
  1. Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
  2. Endocrinology, Princess Margaret Hospital of Children, Subiaco, WA, Australia
  3. Medicine, University of Melbourne, Fitzroy, VIC, Australia
  4. Department of Medicine, University of Sydney, Sydney, NSW, Australia
  5. Department of Endocrinology and Diabetes, The Alfred, Prahran, VIC, AUSTRALIA
  6. The Australian Centre for Behavioural Research in Diabetes, Deakin University, Burwood, VIC, AUSTRALIA
  7. Department of Endocrinology and Diabetes, Royal Melbourne Hospital, Parkville, VIC, Australia
  8. Department of Respiratory and Sleep Medicine, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
  9. Medtronic MiniMed, Northridge, CA, USA
  10. Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Subiaco, WA, Australia

Background: CL insulin delivery improves glycaemic control in patients with T1D although related changes in counter-regulatory hormones have not been studied.

Aim: To evaluate nocturnal glycaemic control, next day glycaemia, and associated changes in counter-regulatory hormones in T1D patients using an overnight CL system at home in comparison with current best available Open Loop (OL) technology represented by SAP-LGS.

Method: Fifteen type 1 diabetes participants (10 adults; 5 adolescents; HbA1c 7.60±0.59%) were assigned in random order to CL with a uni-hormonal artificial pancreas (proportional integral derivative with insulin feedback algorithm) and OL for 1 night in clinic followed by 4 nights at home. On night 4 at 3 AM an orange juice challenge was performed. 

Results: The primary outcome, (sensor glucose time in target range overnight at home: 4.0-8.0 mmol/L) in CL vs. OL, was not statistically different (p=0.19). Sensor glucose time overnight (Mean[SD]) between 4.0 and 10.0 mmol/L was higher with CL vs. OL ( 83.9 [15.2] vs. 74.1[18.8]%; p=0.03). Sensor glucose time and area under the curve below target (< 4.0 mmol/L) were lower with CL: (0.21 [0.44] vs. 4.11 [6.03]%;  p=0.02) and ( 0.01 [0.03] vs. 0.8 [1.11]mmol/min/ L; p=0.01) respectively. The number of symptomatic hypoglycaemic episodes overnight at home confirmed by capillary glucose readings (<4.0 mmol/L) was significantly lower with CL vs. control (8 vs. 21; p=0.015). There were no changes observed in counter-regulatory hormones.

Conclusions: Overnight CL use at home improved percentage time between 4.0-10.0mmol/L, and reduced nocturnal hypoglycaemia compared with OL implemented with SAP-LGS.  The absence of changes observed in counter-regulatory hormones may relate to the small participant numbers and short study duration.

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