Predictors of glycaemic improvement in children and young adults with type 1 diabetes and very elevated HbA1c using the MiniMed 780G system.

IF 5.4 2区医学 Q1 ENDOCRINOLOGY & METABOLISM Diabetes, Obesity & Metabolism Pub Date : 2025-01-20 DOI:10.1111/dom.16210

Yongwen Zhou, Alisa Boucsein, Venus R Michaels, Madeleine K Gray, Craig Jefferies, Esko Wiltshire, Ryan G Paul, Amber Parry-Strong, Maheen Pasha, Goran Petrovski, Martin I de Bock, Benjamin J Wheeler

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Abstract

Aims: This study aimed to identify key factors with the greatest influence on glycaemic outcomes in young individuals with type 1 diabetes (T1D) and very elevated glycaemia after 3 months of automated insulin delivery (AID).

Materials and methods: Data were combined and analysed from two separate and previously published studies with similar inclusion criteria assessing AID (MiniMed 780G) efficacy among young individuals naïve to AID (aged 7-25 years) with glycated haemoglobin A1c (HbA1c) ≥69 mmol/mol (≥8.5%). Univariate and multivariate linear models were performed to explore factors leading to the greatest improvements in HbA1c and time in range 3.9-10.0 mmol/L (70-180 mg/dL; TIR).

Results: A total of 99 young individuals (aged 17.3 ± 4.2 years; baseline HbA1c 92 ± 21 mmol/mol [10.6% ± 1.9%]) were included. After 3 months of AID use, HbA1c improved to 65 ± 16 mmol/mol (8.1% ± 1.5%) (-27 ± 23 mmol/mol; -2.5% ± 2.1% change), and TIR improved from 24.2% ± 13.5% to 58.4% ± 15.4% (p both <0.001). In the multivariate analysis, two key factors for both HbA1c and TIR improvement were identified: high baseline HbA1c (>100 mmol/mol [>11.0%]) and high time in automation mode (>80%), which led to decreased HbA1c by 27.0 mmol/mol (2.4%) and 14.2 mmol/mol (1.3%) and increased TIR by 6.1% and 11.1% (p all <0.05) respectively. Meal announcement frequency >3 times/day and glucose target of 5.5 mmol/L (100 mg/dL) also led to significant increases in TIR. No other factors, including age, prior use of multiple daily injection, ethnicity, gender and optimal active insulin time 2 h, contributed to statistically significant HbA1c or TIR improvement.

Conclusions: In young individuals naive to AID, those with the highest baseline HbA1c and high percentage time in automation experience the greatest benefits after initiation of AID. Sociodemographic background and carbohydrate counting adherence/knowledge should not prevent or delay access to AID technology (ACTRN12621000556842 and ACTRN12622001454763).

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使用MiniMed 780G系统预测患有1型糖尿病和HbA1c非常高的儿童和年轻人的血糖改善

目的：本研究旨在确定对年轻1型糖尿病（T1D）患者血糖结局影响最大的关键因素，这些患者在自动胰岛素给药（AID） 3个月后血糖非常高。材料和方法：对先前发表的两项独立研究的数据进行合并和分析，这些研究的纳入标准相似，评估AID （MiniMed 780G）在糖化血红蛋白A1c (HbA1c)≥69 mmol/mol（≥8.5%）的年轻人naïve对AID（7-25岁）的疗效。采用单因素和多因素线性模型探讨在3.9-10.0 mmol/L (70-180 mg/dL；行动)。结果：共99例青年人(年龄17.3±4.2岁；基线HbA1c为92±21 mmol/mol[10.6%±1.9%])。AID使用3个月后，HbA1c改善至65±16 mmol/mol(8.1%±1.5%)(-27±23 mmol/mol；-2.5%±2.1%的变化)，TIR从24.2%±13.5%提高到58.4%±15.4% （p均为100 mmol/mol[>11.0%]）和自动化模式高时间（>80%），导致HbA1c降低27.0 mmol/mol（2.4%）和14.2 mmol/mol (1.3%)， TIR升高6.1%和11.1% (p均为3次/天，葡萄糖目标为5.5 mmol/L （100 mg/dL）也导致TIR显著升高。没有其他因素，包括年龄、既往多次每日注射、种族、性别和最佳胰岛素活性时间2小时，对HbA1c或TIR的改善有统计学意义。结论：在初次接触AID的年轻人中，那些基线HbA1c最高和自动化时间百分比高的人在开始AID后获益最大。社会人口背景和碳水化合物计数依从性/知识不应阻止或延迟获得AID技术（ACTRN12621000556842和ACTRN12622001454763）。

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来源期刊

Diabetes, Obesity & Metabolism 医学-内分泌学与代谢

CiteScore

10.90

自引率

6.90%

发文量

319

审稿时长

3-8 weeks

期刊介绍： Diabetes, Obesity and Metabolism is primarily a journal of clinical and experimental pharmacology and therapeutics covering the interrelated areas of diabetes, obesity and metabolism. The journal prioritises high-quality original research that reports on the effects of new or existing therapies, including dietary, exercise and lifestyle (non-pharmacological) interventions, in any aspect of metabolic and endocrine disease, either in humans or animal and cellular systems. ‘Metabolism’ may relate to lipids, bone and drug metabolism, or broader aspects of endocrine dysfunction. Preclinical pharmacology, pharmacokinetic studies, meta-analyses and those addressing drug safety and tolerability are also highly suitable for publication in this journal. Original research may be published as a main paper or as a research letter.