The effects of inpatient hybrid closed-loop therapy initiated within 1 week of type 1 diabetes diagnosis
Diabetes Research in Children Network (DirecNet) Study Group, Type 1 Diabetes TrialNet Study Group, Bruce A Buckingham, Roy W Beck, Katrina J Ruedy, Peiyao Cheng, Craig Kollman, Stuart A Weinzimer, Linda A DiMeglio, Andrew A Bremer, Robert Slover, Martin Cantwell, Eva Tsalikian, Michael J Tansey, Julie Coffey, Joanne Cabbage, Sara Salamati, Nelly Mauras, Larry A Fox, Kim Englert, Joe Permuy, Kaitlin Sikes, Bruce A Buckingham, Darrell M Wilson, Paula Clinton, Kimberly Caswell, Stuart A Weinzimer, William V Tamborlane, Jennifer Sherr, Amy Steffen, Kate Weyman, Melinda Zgorski, Eileen Tichy, Neil H White, Ana Maria Arbelaez, Lucy Levandoski, Angie Starnes, Roy W Beck, Katrina J Ruedy, Craig Kollman, Dongyuan Xing, Callyn Hall, Beth Stevens, Gilman D Grave, Karen Winer, Ellen Leschek, Jay S Skyler, Carla J Greenbaum, Norma S Kenyon, Lisa Rafkin, Irene Santiago, Jay M Sosenko, Judith Fradkin, Ellen Leschek, Peter Savage, Lisa Spain, Emily Blumberg, Gerald Beck, Jonathan Braun, David Brillon, Rose Gubitosi-Klug, Lori Laffel, Robert Veatch, Dennis Wallace, Ake Lernmark, Bernard Lo, Herman Mitchell, Ali Naji, Jorn Nerup, Trevor Orchard, Michael Steffes, Anastasios Tsiatis, Bernard Zinman, Jay S Skyler, Mark Anderson, Mark Atkinson, Katarzyna Bourcier, Dorothy Becker, Penelope Bingley, Janice Blum, Emanuele Bosi, Jane Buckner, H Peter Chase, Michael Clare-Salzler, Peter Colman, Linda A DiMeglio, George S Eisenbarth, C Garrison Fathman, Stephen Gitelman, Robin Goland, Peter Gottlieb, Gilman Grave, Carla J Greenbaum, Bernhard Hering, Kevan Herold, Richard Insel, Jeffrey P Krischer, Jennifer Marks, Antoinette Moran, Jerry P Palmer, Mark Peakman, Alberto Pugliese, Philip Raskin, Maria Grazia Roncarolo, William Russell, Peter Savage, Desmond Schatz, Robert Sherwin, Mark Siegelman, Olli Simell, James Thomas, Massimo Trucco, John Wentworth, Diane Wherrett, Darrell M Wilson, William Winter, Judith Fradkin, Ellen Leschek, Lisa Spain, Christophe Benoist, Jeffrey Bluestone, David Brown, Catherine Cowie, Leonard Harrison, Stanley Jordan, Francine R Kaufman, John M Lachin, Jeffrey Mahon, Kirsti Nanto-Salonen, Gerald Nepom, Tihamer Orban, Robertson Parkman, Mark Pescovitz, John Peyman, John Ridge, Henry Rodriguez, John Wagner, Anette Ziegler, Jay S Skyler, Katarzyna Bourcier, Carla J Greenbaum, Jeffrey P Krischer, Ellen Leschek, Lisa Rafkin, Peter Savage, Lisa Spain, Catherine Cowie, Mary Foulkes, Heidi Krause-Steinrauf, John M Lachin, Saul Malozowski, John Peyman, John Ridge, Stephanie J Zafonte, Diabetes Research in Children Network (DirecNet) Study Group, Type 1 Diabetes TrialNet Study Group, Bruce A Buckingham, Roy W Beck, Katrina J Ruedy, Peiyao Cheng, Craig Kollman, Stuart A Weinzimer, Linda A DiMeglio, Andrew A Bremer, Robert Slover, Martin Cantwell, Eva Tsalikian, Michael J Tansey, Julie Coffey, Joanne Cabbage, Sara Salamati, Nelly Mauras, Larry A Fox, Kim Englert, Joe Permuy, Kaitlin Sikes, Bruce A Buckingham, Darrell M Wilson, Paula Clinton, Kimberly Caswell, Stuart A Weinzimer, William V Tamborlane, Jennifer Sherr, Amy Steffen, Kate Weyman, Melinda Zgorski, Eileen Tichy, Neil H White, Ana Maria Arbelaez, Lucy Levandoski, Angie Starnes, Roy W Beck, Katrina J Ruedy, Craig Kollman, Dongyuan Xing, Callyn Hall, Beth Stevens, Gilman D Grave, Karen Winer, Ellen Leschek, Jay S Skyler, Carla J Greenbaum, Norma S Kenyon, Lisa Rafkin, Irene Santiago, Jay M Sosenko, Judith Fradkin, Ellen Leschek, Peter Savage, Lisa Spain, Emily Blumberg, Gerald Beck, Jonathan Braun, David Brillon, Rose Gubitosi-Klug, Lori Laffel, Robert Veatch, Dennis Wallace, Ake Lernmark, Bernard Lo, Herman Mitchell, Ali Naji, Jorn Nerup, Trevor Orchard, Michael Steffes, Anastasios Tsiatis, Bernard Zinman, Jay S Skyler, Mark Anderson, Mark Atkinson, Katarzyna Bourcier, Dorothy Becker, Penelope Bingley, Janice Blum, Emanuele Bosi, Jane Buckner, H Peter Chase, Michael Clare-Salzler, Peter Colman, Linda A DiMeglio, George S Eisenbarth, C Garrison Fathman, Stephen Gitelman, Robin Goland, Peter Gottlieb, Gilman Grave, Carla J Greenbaum, Bernhard Hering, Kevan Herold, Richard Insel, Jeffrey P Krischer, Jennifer Marks, Antoinette Moran, Jerry P Palmer, Mark Peakman, Alberto Pugliese, Philip Raskin, Maria Grazia Roncarolo, William Russell, Peter Savage, Desmond Schatz, Robert Sherwin, Mark Siegelman, Olli Simell, James Thomas, Massimo Trucco, John Wentworth, Diane Wherrett, Darrell M Wilson, William Winter, Judith Fradkin, Ellen Leschek, Lisa Spain, Christophe Benoist, Jeffrey Bluestone, David Brown, Catherine Cowie, Leonard Harrison, Stanley Jordan, Francine R Kaufman, John M Lachin, Jeffrey Mahon, Kirsti Nanto-Salonen, Gerald Nepom, Tihamer Orban, Robertson Parkman, Mark Pescovitz, John Peyman, John Ridge, Henry Rodriguez, John Wagner, Anette Ziegler, Jay S Skyler, Katarzyna Bourcier, Carla J Greenbaum, Jeffrey P Krischer, Ellen Leschek, Lisa Rafkin, Peter Savage, Lisa Spain, Catherine Cowie, Mary Foulkes, Heidi Krause-Steinrauf, John M Lachin, Saul Malozowski, John Peyman, John Ridge, Stephanie J Zafonte
Abstract
Background: This article describes our experience with inpatient hybrid closed-loop control (HCLC) initiated shortly after the diagnosis of type 1 diabetes in a randomized trial designed to assess the effectiveness of inpatient HCLC followed by outpatient sensor-augmented pump (SAP) therapy on the preservation of β-cell function.
Subjects and methods: Forty-eight individuals with newly diagnosed type 1 diabetes and positive pancreatic autoantibodies (7.8-37.7 years old) received inpatient HCLC therapy for up to 93 h, initiated within 7 days of diagnosis.
Results: On initiation of HCLC, mean glucose concentration was 240±100 mg/dL. During the first day of HCLC, median of the participant's mean glucose concentrations fell rapidly to 146 mg/dL, a level of control that was sustained on Days 2 and 3 (138 mg/dL and 139 mg/dL, respectively). By Day 3, the median percentage of glucose values >250 and <60 mg/dL was <1%. During the first 2 weeks of SAP treatment at home, the median participant mean glucose level was 126 mg/dL (interquartile range, 117, 137 mg/dL), and the median percentage of values between 71 and 180 mg/dL was 85% (interquartile range, 80%, 90%).
Conclusions: Inpatient HCLC followed by outpatient SAP therapy can provide a safe and effective means to rapidly reverse glucose toxicity and establish near-normal glycemic control in patients with newly diagnosed type 1 diabetes.
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Source: PubMed