Authors: (including presenting author): :
So WY(1)(3), Tsang CC(1)(2), Hui WS(1)(2), Lam LY(1)(2), Wong IM(1)(3), Wong YY(1)(3), Risa Ozaki(1)(4), Cheung KT(1)(4), Lai CY(1)(2), Yeung SK(1)(2), , Lin LH(1)(3)
Affiliation: :
(1)Department of Medicine, (2)Alice Ho Miu Ling Nethersole Hospital, (3)North District Hospital, (4)Prince of Wales Hospital
Keyword 2: :
Insulin pump
Introduction: :
Suboptimal glycemic control and recurrent hypoglycemia remain common in individuals with type 1 diabetes (TID) treated with multiple daily insulin injections (MDI). Automated insulin pump therapy has been shown to improve glycemic outcomes. Supported by the Alice Wu Memorial Fund and North District Hospital Charity Fund, hybrid closed-loop (HCL) insulin pump therapy was implemented in selected patients deemed to benefit from insulin pump therapy.
Objectives: :
To evaluate metabolic outcomes following transition from MDI to HCL insulin pump therapy in TID.
Methodology: :
Eligible participants were supported for 2-year HCL insulin pump therapy, which included aged 25 to 79 years, patients with T1D using MDI with suboptimal glycemic control as defined by glycated hemoglobin (HbA1c) ≥7.5%, and were capable for use of pump technology and able to afford self-funded use of pump therapy beyond the first 2 years of funded pump therapy. Clinical outcomes before and after pump initiation were retrospectively compared, with one-year outcomes analyzed. Clinical measures included HbA1c, continuous glucose monitoring (CGM) metrics (time in range [TIR] defined as percentage of time glucose levels 3.9–10.0 mmol/L, time below range [TBR] defined as percentage of time glucose levels < 3.9 mmol/L), and total daily insulin dose (TDD).
Result & Outcome: :
Eight patients were selected, but one patient was withdrawn due to skin reactions to CGM adhesives. They were of 32-51 years old, with duration of diabetes ranged from 12 to 38 years (mean 23.8 years). Following 1 year of HCL insulin pump therapy, HbA1c decreased from 7.6–9.5% (mean 8.65%) at baseline to 6.2–7.7% (mean 6.9%), with a mean HbA1c reduction of 1.8%. TIR increased from 35–77% (mean 59.5%) to 67–80% (mean 76.8%), with a mean TIR improvement of 20%. TBR exposure remained minimal, decreasing from 0–5% during MDI to 0–2% with pump therapy. TDD declined from 40–120 units/day (mean 68) to 28–90 units/day (mean 48), with a mean TDD reduction of 19 units/day. Besides improvement in patient outcomes, the program provided the opportunity for diabetologists and diabetes nurses in the use of new advanced diabetes technology, supporting service advancement in Alice Ho Miu Ling Nethersole Hospital and North District Hospital.
