A single-center, observational study found initiating continuous glucose monitoring (CGM) insulin pump therapy in the outpatient setting was safe and effective, especially when combined with supportive patient monitoring through telehealth. These findings were published in Acta Diabetologica.
Patients with type 1 diabetes (T1D) were recruited at the Université Hospital of Lyon (Hospices Civils de Lyon) in France between September 2020 and May 2021. First-time pump users (n=26), those who were switching their device type (n=95), those using sensor-augmented pumps (SAP; n=85), or hybrid closed loop (HCL) systems (n=36) were trained by diabetes nurse educators on using the devices and how to count carbohydrates. After 3 months, patients were monitored via telehealth and assessed for glycated hemoglobin (HbA1C) and glucose metrics.
Patients were 58.6% women, aged median 32.0 (interquartile range [IQR], 20.2-41.4) years, body mass index (BMI) was 23.4 (IQR, 21.3-26.9) kg/m2, diabetes duration was 18.0 (IQR, 9.00-28.0) years, and average baseline HbA1C was 7.95%±0.09%.
All participants improved their diabetes control after switching to CGM and no instances of severe hypoglycemia or diabetic ketoacidosis were reported. At 1 month, only 14.8% reached HbA1C targets. By month 3, 27% in the SAP and 91% in the HCL cohorts reached HbA1C goals.
Final HbA1C was inversely correlated with baseline HbA1C among the HCL cohort (R, -0,8687; 95% CI, -0,9308 to -0,7581; P =.0001) as well was among the SAP cohort (R, -0,3081; 95% CI, -0,5303 to -0,04631; P =.0186).
Comparing the HCL and SAP cohorts, at 3 months SAP users had significantly higher HbA1C (mean, 7.66%±0.1% vs 6.84%±0.05%; P <.001) and coefficient of variation (mean, 39.8±7.35 vs 34.1±0.63; P <.001) and decreased time in range (mean, 53.5±1.88 vs 75.6±1.2; P <.001).
Among adolescent patients (n=26), HbA1C decreased from 8.15% (IQR, 7.7%-8.52%) to 7.75% (IQR, 7.2%-8.12%; P <.0001) after commencing CGM.
This was a single-center study, and these findings may not be generalizable to other patient populations.
The study authors concluded that outpatient initiation and telehealth monitoring of CGM insulin pump initiation was safe among new users and those who were switching from other devices in a real-world setting.
Thivolet C, Gaudilliere M, Fimbel SV, et al. Hybrid closed loop improved glucose control compared to sensor‑augmented pumps in outpatients with type 1 diabetes in real‑life conditions with telehealth monitoring. Acta Diabetol. Published online November 1, 2021. doi:10.1007/s00592-021-01820-9