Virtual Closed-Loop System Training Bolsters Time in Range for Kids With T1D

A virtual educational camp helped kids with type 1 diabetes get the most out of their closed-loop glucose control system, an Italian study showed.

Among 43 children and teens who were using an updated closed-loop system, participation in a virtual educational camp significantly increased time spent in a target glucose range of 70 to 180 mg/dL, from a median of 64% prior to the camp to a median of 75% in the first week after camp (P<0.001), reported Andrea E. Scaramuzza, MD, PhD, of ASST Cremona in Italy, and colleagues.

This improvement was maintained over a 3-week observation period after camp, with a median time in range of 76%, the group noted in JAMA Network Open.

This was “approximately 8% higher than other clinical published data,” they pointed out.

The participants also spent significantly less time in hyperglycemia and severe hyperglycemia:

• Time spent in range of 180-250 mg/dL: 24% at baseline vs 18% after 1 week
• Time spent over 250 mg/dL: 9% vs 4%, respectively

Moreover, the percentage of time the continuous glucose monitor was active increased from 95% at baseline to 99% 1 week after the virtual camp, and average blood glucose levels dropped from 162 mg/dL to 144 mg/dL, respectively.

“Closed-loop control systems, adequately supported by therapeutic education, might help to rapidly improve glycemic control and reach desired therapeutic goals for pediatric patients with type 1 diabetes,” Scaramuzza and team explained.

This “rapid improvement” in glucose levels goes to show just how important is it that patients take the time to learn new systems, they added.

Safety was also maintained after the camp, with no increases in the time spent below target range. Likewise, there were no reports of severe hypoglycemia or diabetic ketoacidosis.

The camp took place after the closed-loop system underwent a software update — from Tandem Basal-IQ technology to Control-IQ technology paired with the t:slim X2 insulin pump. Scaramuzza and colleagues noted that this new technology has been reported to increase time in range by 9% among children and adolescents with type 1 diabetes, “despite the difficulty in achieving glycemic targets in this age group.”

The camp involved a 3-day series of 6-hour Zoom sessions for kids and their parents. Sessions involved either personal trainer-guided exercise classes or informative sessions led by a group of diabetes experts, dietitians, and psychologists, involving carbohydrate counting and instructions on using the upgraded closed-loop system.

The 43 patients (median age 12, 53.5% girls) were recruited from 19 Italian pediatric diabetes centers after the upgraded closed-loop system was introduced. Diabetes duration among the participants ranged from 2 to 13 years (median 6 years). Patients who previously used a closed-loop system for at least 3 months prior while carbohydrate counting were eligible for the study.

Scaramuzza’s group said one limitation to the study was an inability to determine whether the glucose benefits were truly due to the educational sessions, improved technology, or a combination of both.