According to a prospective assessment by 16 diabetes specialists in Spain, advanced Hybrid-Closed-Loop (AHCL) systems improve blood sugar control in patients with type 1 diabetes. The current closed-loop hybrid systems take it a step further by mimicking the body’s natural insulin delivery systems.
The goal of this evaluation was to analyze the results of two AHCLs currently on the market (MM780G with SmartGuard and Tandem t:slimX2 with Control-IQ) and determine their actual benefits based on information provided by the patients.
„Pilar Beato, MD, an endocrinology and nutrition specialist at the University Hospital of Badajoz in Spain, stated,“ The evaluation included 150 patients from 14 centers, 75 for each system, and lasted for three months. An initial assessment was conducted, and another was performed at the end of the three months to determine diabetes control and user satisfaction. Glycated hemoglobin, time in various glycemic ranges, and patient-reported outcomes were evaluated. To consider the quality of life, a 146-point questionnaire was completed to assess all aspects of the condition at a later time.“
The study included adolescent and adult men and women with type 1 diabetes who had not previously been treated with AHCL. After analyzing the results, specialists concluded that both AHCLs significantly improved glucose control. Neither of the AHCLs was superior. Interestingly, the improvement in diabetes-related anxiety was greatest among Control-IQ users. However, there were no differences in the improvement of sleep quality.
Beato, the lead author of the study, said, „There were other previous analyses, but none with a prospective joint assessment with the same design. Our results show that both systems are highly effective, reducing glycated hemoglobin and evaluating the quality of all life parameters. The results are comparable, as various health centers participated. All participating experts are part of the Applied Technology Task Force for Diabetes of the Spanish Diabetes Society. The choice of AHCL to use depends on the specialists and the availability at each site. User preferences should also be considered, as the devices may have individual features that make one more convenient for a particular person. Based on our data, however, there is no clinical indication to prefer one over the other.“
The concept of the two analyzed systems is the same: they both have a glucose sensor that continually takes measurements and both transmit the information in real-time to the system algorithms, which decide how much insulin should be delivered, thus controlling glucose highs and lows. They differ in the design of the system components and in the technique of the algorithms. However, it is important to note that the information for treating diabetes and the required amount of insulin are obtained by the patient himself. The automation of the systems corrects glucose fluctuations even within a single day, as several factors such as diet, nerves, or exercise can influence glucose levels.
„In the event of an incident or problem, initial training and support are required, but it does not necessarily require more counseling time, as they are automated systems and are able to automatically correct glucose peaks that may occur in a person. This may even take less time.“ „Of course, patients must continue to be regularly monitored endocrinologically,“ said Beato.
These technologies are supported by international scientific societies, which increasingly recognize the benefits of such devices. The societies therefore recommend that closed-loop hybrid systems should be the standard for treating people with type 1 diabetes, as they are more effective than conventional multi-dose insulin therapy. They have been recommended by the American Diabetes Association since 2022 and by the National Institute for Health and Care Excellence guidelines since January 2023.
Beato regrets that the use of these devices is not widespread in Spain. „We do not have data on the percentage of people using them, but we have the impression that this number is low and insufficient. We need a push and the removal of some barriers, such as the cost. Ultimately, the devices will reduce the costs of diabetes control, as they are designed for better glucose control. They will reduce hospitalizations for complications such as diabetic retinopathy or hypoglycemia. They will also reduce absenteeism in school and the workplace. I am sure that the systems will be smaller in the future, which will be more suitable for users.“
„This article was translated by“ „Univadis Spain,“ „a part of the Medscape Professional Network.“