Diabetes Dialogue: T1D Glycemic Improvement and CRISTAL at ATTD 2024

In this special conference edition episode of Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives, hosts Diana Isaacs, PharmD, an endocrine clinical pharmacist, director of Education and Training in Diabetes Technology, and codirector of Endocrine Disorders in Pregnancy at the Cleveland Clinic, and Natalie Bellini, DNP, program director of Diabetes Technology at University Hospitals Diabetes and Metabolic Care Center provide insight from automated insulin delivery updates from the 17th annual International Conference on Advanced Technologies & Treatments for Diabetes. The specific topics of note covered in this study include new data related to diabetes technology use from the Type 1 Diabetes (T1D) Exchange and a read-out of data from the CRISTAL trial.

T1D Exchange Data

At ATTD 2024, the community was given further insight into trends of glycemic control among people with type 1 diabetes in recent years. Specifically, investigators presented data related to a cohort of top 81,445 people with type 1 diabetes recorded from 2016-2023 as part of the T1D Exchange Quality Improvement collaborative.

Analysis of data from this cohort suggested the mean HbA1c fell from 8.8% in 2016-2017 to 8.1% in 2022‐2023 (P < .01). Investigators pointed out the observed improvements were not equally distributed across all racial and ethnic groups. When assessing trends beyond glucose control, results pointed to absolute increases in the proportion of people using a continuous glucose monitor, insulin pump, or automated insulin delivery system by 59%, 17%, and 35%, respectively. Investigators also pointed out the absolute increases in technology, differences by race‐ethnicity, and insurance were all statistically significant (P < .01).

CRISTAL Read-Out

Management of diabetes during pregnancy, as discussed in previous episodes, remains a hotbed for ongoing research. The CRISTAL study was a multicenter, randomized, controlled trial examining the use of closed-loop insulin delivery, with the MiniMed 780G HCL system, relative to standard of care in women with type 1 diabetes who were pregnant. To be included in the trial, female patients needed to be 18-45 years of age with a type 1 diabetes diagnosis of at least 1 year, an HbA1c less than or equal to 10%, and confirmed singleton pregnancy up to 11 weeks 6 days.

At ATTD 2024, investigators presented data from 89 patients included in the study. Among this cohort, 43 women used the MiniMed 780G and 46 used a glucose sensor and received multiple daily injections or an insulin pump.

Primary results of the trial demonstrated use of the MiniMed 780G was safe for use during pregnancy. Further analysis indicated use was no associated with improvements in timing in range during pregnancy relative to the standard of care group (66.5±10.0 vs 63.2±12.4; P=.17), but use was associated with improved overnight time in range during pregnancy (75.1±13.1 vs 67.2±14.6; P=.0026), reduced time below range during pregnancy (2.5±2.8 vs 4.1±3.4; P=.002), less hypoglycemia unawareness, less glycemic variability, and improved treatment satisfaction.

Relevant disclosures for Dr. Isaacs include Eli Lilly and Company, Novo Nordisk, Sanofi, Abbott Diabetes Care, Dexcom, Medtronic, and others. Relevant disclosures for Dr. Bellini include Abbott Diabetes Care, MannKind, Provention Bio, and others.

References:

1. T1D Exchange. Type 1 diabetes glycemic outcomes are improving: Real world data of over 80,000 people in the T1D Exchange Quality Improvement Collaborative. T1D Exchange. March 12, 2024. Accessed March 26, 2024. https://t1dexchange.org/type-1-diabetes-glycemic-outcomes-are-improving-real-world-data-of-over-80000-people-in-the-t1d-exchange-quality-improvement-collaborative/.
2. Benhalima K. Randomized controlled trial of the MiniMed 780G system compared to standard insulin therapy in pregnant women with type 1 diabetes: the CRISTAL study. Paper presented at: 17th annual International Conference on Advanced Technologies & Treatments for Diabetes; March 7 - 9; Florence, Italy. Accessed March 26, 2024.