Hybrid Closed-loop to Manage Gastroparesis in People With Type 1 Diabetes: a Case Series.
J Diabetes Sci Technol
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Daly, A., Hartnell, S., Boughton, C. K., & Evans, M. (2021). Hybrid Closed-loop to Manage Gastroparesis in People With Type 1 Diabetes: a Case Series.. J Diabetes Sci Technol, 15 (6), 1216-1223. https://doi.org/10.1177/19322968211035447
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.
Special Section: The Artificial Pancreas: Improving Clinical Performance, continuous glucose monitoring, diabetes technology, gastroparesis, hybrid closed-loop, type 1 diabetes
External DOI: https://doi.org/10.1177/19322968211035447
This record's URL: https://www.repository.cam.ac.uk/handle/1810/330197
Embargo: ends 2021-08-11