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NEW ORLEANS – Among the new users of MiniMed 670G The closed-loop hybrid insulin delivery system (Medtronic), nearly 40% having stopped using the device after 9 months, mainly due to technical difficulties, says a new search presented here at the annual ENDO 2019 conference: The Endocrine Society.
Closed-loop insulin pump therapy is the most advanced technology available to date for type 1 diabetes. It's "theoretically brilliant, and it's the future," he said. Lead co-investigator Gregory Goodwin, of the Boston Children's Hospital, but "we need better systems," he said at a press briefing.
"For this to be available and convenient for the average patient with type 1 diabetes, we need a more user-friendly technology," he said. "Anyone who cares about patients knows that's the case," he added.
The author of a previous study on this topic, Gregory P. Forlenza, MD, badistant professor of pediatrics at the Barbara Davis Center for Diabetes, in Aurora, Colorado, compared the MiniMed 670G to "a cell phone of the 1990s " Medscape Medical News Last year, "This is not an iPhone 6.0 .It is a giant step in the automation of insulin administration, but this n & # 39; Is not a plug-and-play system. "
Anders L. Carlson, MD, Medical Director of the International Diabetes Center in Minneapolis, Minnesota, agreed.
"Automated delivery of insulin, it's the future," he told reporters at ENDO 2019, "but the sensors need to improve."
And he noted that technology is not the only obstacle.
Although the US patient data for type 1 diabetes indicates insulin pumps and continuous glucose monitors (CGMs, also known as "sensors") – components of closed-loop systems – are increasingly being used at home. United States. about half of the patients use this technology, noted Carlson.
"There is a chance we can leave some people behind if we do not deal with issues such as socio-economic differences," he said.
Why do not patients stick to the system? "It's a full-time job"
Goodwin explained that he and his colleagues "wanted to see how the MiniMed 670G works in the real world".
In closed-loop hybrid systems, communication between the insulin pump and the CGM is algorithm-based, and basal insulin administration is automated to minimize low and high glucose readings, but the patient must always enter information on carbohydrate consumption.
The first such system to be marketed, the MiniMed 670G , has been approved by the US Food and Drug Administration in 2016 for use in patients aged 14 years and older. In June 2018, this program was extended to people aged 7 and over.
Patients are eligible for the MiniMed 670G if they have already used an insulin pump and a CGM, have expressed a preference for the device and have obtained approval from their attending endocrinologist or nurse educator, explained Goodwin. .
From May 2017 to August 2018, her clinic had 93 patients who chose to start a treatment with the MiniMed 670G, ages 5 to 25, with an average age of 17 years. (Goodwin stated that although the device is only approved for patients 7 years of age and older, they use it in their facility, at the discretion of the attending clinician, in those age 5 and older).
Of the 93 patients, 35 (38%) stopped using the MiniMed 670G in an average of 9 months after starting the device, which constitutes "one of the longest tracking data" so far for users of this system, Goodwin said.
The reasons for discontinuing use include frequent alarms, forced exits from automatic mode. Users must return to manual mode, calibration requirements, premature sensor failure, skin adhesion problems, and sensor power problems, he noted.
But overall, the majority of patients withdrew because they "had been kicked out of automatic mode," Goodwin said, explaining that "if you do not meet certain conditions, the system will knock you out."
"Most of the patients who have withdrawn have completely withdrawn," he said.
"It's a full-time job, just to stay in the target."
Among patients who continued to use the MiniMed 670G (62% of patients), those who managed to stay in automatic mode more than 57% of the time saw a significant reduction in HbA1 Che noted.
Goodwin concluded that to improve compliance with these devices and "improve success", manufacturers must "decrease the frequency of alarms and the frequency of forced exits from automatic mode".
There is now a new sensor available with the MiniMed 670G that uses fewer forced outputs in automatic mode, he said, adding that "it was the first generation of the system. It will improve with the time".
And he said Medscape Medical News that there is a lot of interest of companies to develop closed loop hybrid systems using the Dexcom G6 sensor, which was approved in the United States last year.
Goodwin and Carlson have not reported any relevant financial relationship.
ENDO 2019. Presented 24 March 2019. Summary OR14-5.
Follow Lisa Nainggolan on Twitter: @ lisanainggolan1. For more information on diabetes and endocrinology, follow us on Twitter and on Facebook.
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