Advanced Hybrid Closed-Loop Technology Could Improve Quality of Life in Type 1 Diabetes

Katarzyna Cyranka, PhD, MA
Credit: University Hospital in Krakow

A study of adults with type 1 diabetes naive to advanced diabetes technology is underlining the potential benefit of newer technologies in diabetes management.

Results of the study, which examined quality of life over 1-year after initiating use of an advanced hybrid closed-loop system, suggest use of diabetes technology was associated with notable improvements in quality of life.¹

“To the best of our knowledge, this is the first long-term follow-up study investigating the psychological well-being of adult people with T1D previously naïve to diabetes technology (treated with [multiple daily injections] and [self-monitoring of blood glucose]) who experience a direct switch to the [advanced hybrid closed loop] system with novel calibration-free sensors, and the sustainability of the obtained changes in their quality of life,” wrote investigators.¹

As the rate of advancement and endorsement among guidelines for diabetes technology continues to progress, optimal uptake of new technologies has become a focal point of research for many within the community. The current study was designed by a team of investigators from institutions in Poland led by Katarzyna Cyranka, PhD, MA, of the University Hospital in Krakow, as a 9-month observational continuation of a 3-month randomized controlled trial, with the aim of exploring the effect of 1-year of use of an advanced hybrid closed-loop system on quality of life, level of anxiety, and self-efficacy.¹

In the original trial, 41 patients were randomized to advanced hybrid closed loop therapy with the MiniMed 780G advanced hybrid closed-loop system or to remain on multiple daily injections and self-monitoring of blood glucose. Overall, 20 and 21 patients were randomized to the intervention and control arm, respectively.²

A total of 37 patients completed the study. At 3 months, time in range increased from 69.3% (Standard deviation [SD], 12.3) at baseline to 85.0% (SD, 6.3) at 3 months in the advanced hybrid group, while remaining unchanged in the control group (treatment effect 21.5% [95% Confidence interval [CI] 15.727.3]; P < 0.001).²

From the original study, 18 participants from the intervention group continued use in the 9-month observational continuation period. This cohort consisted of 10 men and 8 women, with a mean age of 40.9 (SD, 7.6) years. Of note, at month 6 of the study, patients were switched from the Guardian Sensor 3 to the Guardian Sensor 4 Continuous Glucose Monitoring system.¹

The primary outcomes of interest for the trial were change in quality of life, level of anxiety, and level of self-efficacy. Investigators pointed out quality of life was assessed using the Polish validated version of the ‘QoL-Q Diabetes’ questionnaire, level of anxiety was assessed using the State-Trait Anxiety Inventory (STAI), and self-efficacy was assessed using the General Self-Efficacy Scale (GSES).¹

Upon analysis, results pointed to significant increases in quality of life for the global QOL-Q Diabetes questionnaire score, with significant increases observed in as many as 11 of 23 areas of life. These areas included being physically active (P = .02; Cohen d = .71), feeling well (P <.01; Cohen d = 0.73), feeling in control of my body (P <.01; Cohen d = 0.72), looking good (P <.01; Cohen d = 1.07), working (P <.01; Cohen d = 1.12); sleeping (P = .01, Cohen d = .66), eating as I would like (P <.01; Cohen d = .79), looking after or being useful to others (P = .02; Cohen d = 0.65), being active with pets/animals (P <.01; Cohen d = .95), being spontaneous (P = .02; Cohen d = .67), and doing “normal” things (P = .02; Cohen d = .67).¹

Further analysis revealed use of the advanced hybrid closed-loop system was also associated with improvements in both state (P = .04; Cohen d = .56) and trait (P = .02; Cohen d = .60) anxiety as well as self-efficacy (P = .03; Cohen d = .76). Investigators also pointed out there were no instances of pump discontinuation during the study.¹

“Evaluation of patients’ [quality of life] is a well-grounded indicator of the effectiveness of provided healthcare and may be helpful for health professionals and healthcare policymakers in their efforts to improve the well-being of patients,” wrote investigators.¹

References:

1. Cyranka K, Matejko B, Juza A, et al. Quality of life in the course of a one-year use of an advanced hybrid closed-loop system in adults with type 1 diabetes previously naïve to advanced diabetes technology. Front Endocrinol (Lausanne). 2023;14:1210756. Published 2023 Aug 15. doi:10.3389/fendo.2023.1210756
2. Matejko B, Juza A, Kieć-Wilk B, et al. Transitioning of People With Type 1 Diabetes From Multiple Daily Injections and Self-Monitoring of Blood Glucose Directly to MiniMed 780G Advanced Hybrid Closed-Loop System: A Two-Center, Randomized, Controlled Study. Diabetes Care. 2022;45(11):2628-2635. doi:10.2337/dc22-0470