Automated insulin delivery among adults with type 1 diabetes for up to 2 years: a real-world, multicentre study.

Autor: Donaldson LE; Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.; Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.; Department of Diabetes and Endocrinology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia., Fourlanos S; Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.; Department of Diabetes and Endocrinology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.; Australian Centre for Accelerating Diabetes Innovations (ACADI), The University of Melbourne, Melbourne, Victoria, Australia., Vogrin S; Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia., MacIsaac RJ; Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.; Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.; Australian Centre for Accelerating Diabetes Innovations (ACADI), The University of Melbourne, Melbourne, Victoria, Australia., Colman PG; Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.; Department of Diabetes and Endocrinology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia., McAuley SA; Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.; Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
Jazyk: angličtina
Zdroj: Internal medicine journal [Intern Med J] 2024 Jan; Vol. 54 (1), pp. 121-128. Date of Electronic Publication: 2023 Jun 16.
DOI: 10.1111/imj.16143
Abstrakt: Background and Aims: Automated insulin delivery (AID) improves glycaemia among people with type 1 diabetes in clinical trials and overseas real-world studies. Whether improvements are sustained beyond 12 months in the real world, and whether they occur in the Australian context, has not yet been established. We aimed to observe, up to 2 years, the effectiveness of initiating first-generation AID for type 1 diabetes management.
Methods: Retrospective, real-world, observational study using medical records, conducted across five sites in Australia. Adults with type 1 diabetes, who had AID initiated between February 2019 and December 2021, were observed for 6-24 months after initiation (until June 2022). Outcomes examined included glucose metrics assessed by glycated haemoglobin (HbA 1c ) and continuous glucose monitoring (CGM), safety and therapy continuation.
Results: Ninety-four adults were studied (median age 39 years (interquartile range, IQR: 31-51); pre-initiation HbA 1c 7.8% (7.2-8.6)). After AID initiation, HbA 1c decreased by mean 0.5 percentage points (95% confidence interval (CI): -0.7 to -0.2) at 3 months (P < 0.001); CGM time in range 3.9-10.0 mmol/L increased by 11 percentage points (9-14) at 1 month (P < 0.001); these improvements were maintained up to 24 months (all P < 0.02). Median CGM time below 3.9 mmol/L was <1.5% pre- and post-AID initiation. The subgroup with pre-initiation HbA 1c above 8.5% had the greatest HbA 1c improvement (-1.4 percentage points (-1.8 to -1.1) at 3 months). Twelve individuals (13%) discontinued AID, predominantly citing difficulties with CGM. During the 150 person-years observed, four diabetes-related emergencies were documented: three severe hypoglycaemic events and one hyperglycaemic event without ketoacidosis.
Conclusions: Early glucose improvements were observed after real-world AID initiation, sustained up to 2 years, without excess adverse events. The greatest benefits were observed among individuals with highest glycaemia before initiation. Future-generation systems with increased user-friendliness may enhance therapy continuation.
(© 2023 The Authors. Internal Medicine Journal published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Physicians.)
Databáze: MEDLINE
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