The new hybrid closed-loop insulin pump is proving difficult to use in some diabetic patients

According to the researchers, among new users of a new insulin pump automatically providing insulin to people with type 1 diabetes, nearly a fifth have stopped using it. device, mainly due to difficulties in meeting the technical requirements management system. The results of a real-life study of the hybrid closed-loop insulin pump (Medtronic MiniMed 670G) will be presented Sunday at the annual meeting of the Endocrine Society in New Orleans, Louisiana.

"Closed-loop insulin pump therapy has been the most exciting development in type 1 diabetes for decades because it acts like an artificial pancreas," said co-principal Gregory Goodwin, MD, badistant physician. in Medicine at Boston Children's Hospital, Messe. "But this technology needs to become more user-friendly."

The MiniMed 670G is the first insulin pump approved by the Food and Drug Administration that automatically delivers basal or basal insulin to control blood sugar changes throughout the day, according to the manufacturer, which n & # 39; 39 did not finance this study. Unlike standard insulin pumps, which can continue to deliver insulin even when the blood glucose is too low, the new system will shut down in this situation or deliver less insulin, Goodwin said. The device, he explained, still forces users to calibrate their blood glucose values ​​between the badociated sensor, called the continuous blood glucose monitor (CBGM), and their finger blood tests.

Goodwin and his colleagues at the hospital's diabetes clinic prescribed the device to 83 patients who had applied for it between May 2017 and September 2018 and had previously used an insulin pump and a CGM. A manufacturer's representative trained patients on the system. The patients were between the ages of 6 and 25, especially in adolescence. The pump is now approved for children 7 years and older, but until June 2018, it was approved for patients 14 years and older.

Sixteen patients (19%) stopped using the new technology in a few months, reported the research team. Goodwin stated that the main reasons for the abandonment were the fact that too much calibration or dissatisfaction with the device was required, forcing the system to leave the automatic mode for various reasons. On average, 67 patients, or 81%, continued to use the automatic mode, in contrast to the manual adjustment of insulin levels, but the duration in automatic mode varied considerably, ranging from 10 to 90%.

A total of 58 patients who continued to use auto mode had A1C hemoglobin values ​​- a measure of glycemic control over several months – six months before and six months after the start of the use of the device. On average, after 97 days of using the technology in automatic mode, the group recorded a 0.2% decline in A1C. Although this improvement was statistically significant, the decrease was lower than that reported in the controlled research studies.

"Patients can take full advantage of the system's automatic mode," said Dr. Goodwin, "but this technology is demanding and requires the use of a technically sophisticated patient or parent. "

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Provided by
The endocrine society