Impact of Advanced Hybrid Closed Loop on Youth With High-Risk Type 1 Diabetes Using Multiple Daily Injections
Abstract
Objective To evaluate glycemic outcomes in youth (aged 13-25 years) with type 1 diabetes and high-risk glycemic control (HbA1c ≥8.5% [69 mmol/mol]) on multiple daily injection (MDI) therapy after transitioning to advanced hybrid closed loop (AHCL) therapy. Research design and methods This prospective, 3-month, single-arm, dual-center study enrolled 20 participants, and all completed the study. Results HbA1c decreased from 10.5 ± 2.1% (91.2 ± 22.8 mmol/mol) at baseline to 7.6 ± 1.1% (59.7 ± 11.9 mmol/mol), and time spent in target range 70-180 mg/dL (3.9-10.0 mmol/L) increased from 27.6 ± 13.2% at baseline to 66.5 ± 9.8% after 3 months of AHCL. Two episodes of diabetic ketoacidosis attributed to infusion set failure occurred. Conclusions AHCL has the potential to improve suboptimal glycemia in youth with type 1 diabetes previously on MDI therapy.
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Socially disadvantaged groups may have greater absolute benefit from initiating diabetes technologies given their higher HbA1c.
“However, socially disadvantaged groups may in fact have greater absolute benefit from initiating these technologies 39 , 40 given their higher HbA1c, and should be prioritised for AID.”
Cites
Six-Month Randomized, Multicenter Trial of Closed-Loop Control in Type 1 Diabetes
Brown, S. A., Kovatchev, B. P., Raghinaru, D., Lum, J. W., Buckingham, B. A., Kudva, Y. C., Laffel, L. M., Levy, C. J., Pinsker, J. E., Wadwa, R. P., et al. (2019) · New England Journal of Medicine · doi:10.1056/nejmoa1907863 · Cited by 1,030 · see citing works
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Khodabandehloo, P., Fakembe, P., Senga, J., Shulman, R., Lipscombe, L. L., Witteman, H. O., Banerjee, A., Presseau, J., Nakhla, M., Dogba, M. J., et al. (2025) · Diabetes, Obesity and Metabolism · doi:10.1111/dom.16426 · Cited by 6 · see citing works
“13 However, socially disadvantaged groups may in fact have greater absolute benefit from initiating these technologies 39,40 given their higher HbA1c, and should be prioritised for AID.”
- Authors
- Boucsein, A., Watson, A. S., Frewen, C. M., Sanders, O. J., Haszard, J. J., Jones, S. D., Milford-Hughes, P. J., de Bock, M. I., & Wheeler, B. J.
- Affiliations
- University of Otago (NZ)
- 2Department of Paediatrics, University of Otago, Christchurch, New Zealand
- Health New Zealand (NZ)
- Corresponding author
- Wheeler, Benjamin J.
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2023-01-23
- Volume
- 46
- Issue
- 3
- Pages
- 628-632
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W4317796991
- Cited by
- 40
- References
- 5
- Citations by year
- 2026: 7 · 2025: 11 · 2024: 16 · 2023: 6
- FWCI
- 8.16
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Lottery Health Research (LHR-2021-153881)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Keywords
- type 1 diabetes, multiple daily insulin injections, glycemic control, HbA1c, time in range, youth, insulin pump therapy, diabetic ketoacidosis
- MeSH terms
- Adolescent, Adult, Blood Glucose, Diabetes Mellitus, Type 1, Glycated Hemoglobin, Humans, Hypoglycemic Agents, Insulin, Insulin Infusion Systems, Prospective Studies, Blood Glucose Self-Monitoring, Young Adult
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