DSTJournal of Diabetes Science and Technology1932-29681932-2968SAGE PublicationsSage CA: Los Angeles, CA10.1177/1932296821103544710.1177_19322968211035447Special Section: The Artificial Pancreas: Improving Clinical PerformanceGuest Editors: Ali Cinar, Charlotte Boughton, Peter Jacobs, and Josep VehiHybrid Closed-loop to Manage Gastroparesis in People With Type 1 Diabetes: a Case Serieshttps://orcid.org/0000-0001-5003-9630DalyAideenMB BCh1HartnellSaraBSc2https://orcid.org/0000-0003-3272-9544BoughtonCharlotte K.MD PhD12https://orcid.org/0000-0001-8122-8987EvansMarkMD12Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UKWolfson Diabetes and Endocrine Clinic, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UKAideen Daly, MB BCh, Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Level 4, Addenbrookes Hospital, Cambridge, CB2 0QQ, UK. Email: ad2075@medschl.cam.ac.uk118202115612161223© 2021 Diabetes Technology Society2021Diabetes Technology Societyhttps://creativecommons.org/licenses/by/4.0/This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).Background:

Gastroparesis is associated with unpredictable gastric emptying and can lead to erratic glucose profiles and negative impacts on quality-of-life. Many people with gastroparesis are unable to meet glycemic targets and there is a need for new approaches for this population. Hybrid closed-loop systems improve glucose control and quality-of-life but evidence for their use in people with diabetic gastroparesis is limited.

Methods:

We present a narrative review of the challenges associated with type 1 diabetes management for people with gastroparesis and present a case series of 7 people with type 1 diabetes and gastroparesis. We compare glycemic control before and during the first 12 months of hybrid closed-loop therapy. Data were analyzed using electronic patient records and glucose management platforms. We also discuss future advancements for closed-loop systems that may benefit this population.

Results:

Five of 7 patients had data available for time in range before and during hybrid closed-loop therapy, and all had an improvement in percentage time in target glucose range, with the overall mean time in range increasing from 26.0% ± 15.7% to 58.4% ± 8.6% during HCL use, (P = .004). There were significant reductions in HbA1c (83 ± 9 mmol/mol to 71 ± 14 mmol/mol) and mean glucose from 13.0 ± 1.7 mmol/L (234 ± 31 mg/dL) to 10.0 ± 0.7 mmol/L (180 ± 13 mg/dL) with use of a hybrid closed-loop system. Importantly, this was achieved without an increase in time in hypoglycemia (P = .50).

Conclusion:

Hybrid closed-loop systems may represent a valuable approach to improve glycemic control for people with type 1 diabetes and gastroparesis. Prospective studies are required to confirm these findings.

continuous glucose monitoringdiabetes technologygastroparesishybrid closed-looptype 1 diabetestypesetterts1