Sustained effectiveness of an advanced hybrid closed loop system in a cohort of children and adolescents with type 1 diabetes: a one-year real-world study

Objective. To investigate glucose metrics and identify potential predictors of the achievement of glycemic outcomes in children and adolescents during their first 12 months of MiniMed™ 780G use. Research design and methods. In this multicenter, longitudinal, real-world study, 368 children and adolescents with type 1 diabetes starting SmartGuard technology between June 2020 and June 2022 were recruited. Ambulatory glucose profile data were collected during a 15-day run-in period (baseline), two weeks after automatic mode activation, and every 3 months. The influence of covariates on glycemic outcomes after 1 year of Minimed™ 780G use was assessed. Results. After 15 days of automatic mode use, all glucose metrics improved compared to baseline (p<0.001), except for time below range and coefficient of variation (p=0.113 and p=0.330, respectively). After one year, time in range (TIR) remained significantly higher than at baseline (75.3% vs 62.8%, p<0.001). The mean glycated hemoglobin over the study duration was lower than the previous year (6.9 ± 0.6% vs 7.4 ± 0.9%, p<0.001). Time spent in tight range (70-140 mg/dl) was 51.1% and glycemia risk index was 27.6. Higher TIR levels were associated with a reduced number of automatic correction boluses (p<0.001), fewer SmartGuard exits (p=0.021), and longer time in automatic mode (p=0.030). Individuals with baseline HbA1c > 8% showed more relevant improvement in TIR levels (from 54.3% to 72.3%). Conclusions. Our study highlights the sustained effectiveness of Minimed™ 780G among youths with T1D. Findings suggest that even children and adolescents with low therapeutic engagement may benefit from SmartGuard technology.