Efficacy and Safety of Different Hybrid Closed Loop Systems for Automated Insulin Delivery in People With Type 1 Diabetes: A Systematic Review and Network Meta-Analysis

IF 4.6 2区医学 Q1 ENDOCRINOLOGY & METABOLISM Diabetes/Metabolism Research and Reviews Pub Date : 2024-09-19 DOI:10.1002/dmrr.3842

Sergio Di Molfetta, Ludovico Di Gioia, Irene Caruso, Angelo Cignarelli, Suetonia C. Green, Patrizia Natale, Giovanni F. M. Strippoli, Gian Pio Sorice, Sebastio Perrini, Annalisa Natalicchio, Luigi Laviola, Francesco Giorgino

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Abstract

Aims

To compare the efficacy and safety of different hybrid closed loop (HCL) systems in people with diabetes through a network meta-analysis.

Methods

We searched MEDLINE, EMBASE, CENTRAL and PubMed for randomised clinical trials (RCTs) enrolling children, adolescents and/or adults with type 1 or type 2 diabetes, evaluating Minimed 670G, Minimed 780G, Control-IQ, CamAPS Fx, DBLG-1, DBLHU, and Omnipod 5 HCL systems against other types of insulin therapy, and reporting time in target range (TIR) as outcome.

Results

A total of 28 RCTs, all enrolling people with type 1 diabetes, were included. HCL systems significantly increased TIR compared with subcutaneous insulin therapy without continuous glucose monitoring (SIT). Minimed 780G achieved the highest TIR ahead of Control IQ (mean difference (MD) 5.1%, 95% confidence interval (95% CI) [0.68; 9.52], low certainty), Minimed 670G (MD 7.48%, 95% CI [4.27; 10.7], moderate certainty), CamAPS Fx (MD 8.94%, 95% CI [4.35; 13.54], low certainty), and DBLG1 (MD 10.69%, 95% CI [5.73; 15.65], low certainty). All HCL systems decreased time below target range, with DBLG1 (MD −3.69%, 95% CI [−5.2; −2.19], high certainty), Minimed 670G (MD −2.9%, 95% CI [−3.77; −2.04], moderate certainty) and Minimed 780G (MD −2.79%, 95% CI [−3.94; −1.64], high certainty) exhibiting the largest reductions compared to SIT. The risk of severe hypoglycaemia and diabetic ketoacidosis was similar to other types of insulin therapy.

Conclusions

We show a hierarchy of efficacy among the different HCL systems in people with type 1 diabetes, thus providing support to clinical decision-making.

Trial Registration: PROSPERO CRD42023453717

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用于 1 型糖尿病患者胰岛素自动输送的不同混合闭环系统的有效性和安全性：系统回顾与网络元分析

目的通过网络荟萃分析比较不同混合闭环 (HCL) 系统对糖尿病患者的疗效和安全性。方法我们检索了MEDLINE、EMBASE、CENTRAL和PubMed上的随机临床试验（RCT），这些试验招募了1型或2型糖尿病儿童、青少年和/或成人患者，评估了Minimed 670G、Minimed 780G、Control-IQ、CamAPS Fx、DBLG-1、DBLHU和Omnipod 5 HCL系统与其他类型的胰岛素疗法，并将目标范围内时间（TIR）作为结果报告。结果共纳入了 28 项 RCT 研究，所有研究都有 1 型糖尿病患者参加。与不使用连续血糖监测（SIT）的皮下注射胰岛素疗法相比，HCL 系统能明显增加目标范围时间。Minimed 780G 的 TIR 最高，领先于 Control IQ（平均差 (MD) 5.1%，95% 置信区间 (95% CI) [0.68; 9.52]，低确定性）、Minimed 670G（MD 7.48%，95% CI [4.27；10.7]，中等确定性）、CamAPS Fx（MD 8.94%，95% CI [4.35；13.54]，低确定性）和 DBLG1（MD 10.69%，95% CI [5.73；15.65]，低确定性）。与 SIT 相比，所有 HCL 系统均可减少低于目标范围的时间，其中 DBLG1（MD -3.69%，95% CI [-5.2; -2.19]，高度确定性）、Minimed 670G（MD -2.9%，95% CI [-3.77; -2.04]，中度确定性）和 Minimed 780G（MD -2.79%，95% CI [-3.94; -1.64] ，高度确定性）的减少幅度最大。严重低血糖和糖尿病酮症酸中毒的风险与其他类型的胰岛素疗法相似。结论我们显示了不同的 HCL 系统对 1 型糖尿病患者的不同疗效，从而为临床决策提供了支持。试验注册：PROPERCO CRD42023453717

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来源期刊

Diabetes/Metabolism Research and Reviews 医学-内分泌学与代谢

CiteScore

17.20

自引率

2.50%

发文量

审稿时长

4-8 weeks

期刊介绍： Diabetes/Metabolism Research and Reviews is a premier endocrinology and metabolism journal esteemed by clinicians and researchers alike. Encompassing a wide spectrum of topics including diabetes, endocrinology, metabolism, and obesity, the journal eagerly accepts submissions ranging from clinical studies to basic and translational research, as well as reviews exploring historical progress, controversial issues, and prominent opinions in the field. Join us in advancing knowledge and understanding in the realm of diabetes and metabolism.