Simplified Meal Announcement versus Precise Carbohydrate Counting in Adolescents with Type 1 Diabetes using the MiniMed 780G Advanced Hybrid Closed Loop System: A Randomized Controlled Trial Comparing Glucose Control

Objective. We aimed to compare glucose control in adolescents with Type 1 Diabetes (T1D) on MiniMed 780G system that used simplified meal announcement to those that used precise carbohydrate counting. 

Research Design and Methods. This randomized controlled trial included 34 participants (12-18 years) with T1D that were on multiple daily injections or insulin pump and were scheduled to start using MiniMed 780G system at Sidra Medicine, Qatar. After a 7-day run-in period, participants were randomly assigned to the Fix group (simplified meal announcement by preset of 3 personalized fixed carbohydrate amounts) or the Flex group (precise carbohydrate counting) and followed for 12 weeks. Between-group difference in time in range (TIR) was the primary endpoint. Secondary endpoints included HbA1c and other glycometrics.

Results. During the 12-week study phase, TIR was 73.5±6.7% in the Fix and 80.3±7.4% in the Flex group, with a between-group difference of 6.8% in favor of Flex (p=0.043). Time above 250 mg/dl was better in the Flex group (p=0.012), whereas HbA1c (p=0.168), time below range (p=0.283) and time between 180-250 mg/dL (p=0.114) did not differ. 

Conclusion. Adolescents on the MiniMed 780G system using a preset of 3 personalized fixed carbohydrate amounts can reach international targets of glycemic control. Therefore, it may be a valuable alternative to precise carbohydrate counting in users who are challenged by precise carbohydrate counting. Because carbohydrate counting further improves outcomes, these skills remain important for MiniMed 780G users.