Open AccessHybrid Closed-loop to Manage Gastroparesis in People With Type 1 Diabetes: a Case Series
Author(s) -
Aideen Daly,
Sara Hartnell,
Charlotte K Boughton,
Mark L. Evans
Publication year - 2021
Publication title -
journal of diabetes science and technology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.039
H-Index - 75
eISSN - 1932-3107
pISSN - 1932-2968
DOI - 10.1177/19322968211035447
Subject(s) - gastroparesis , type 2 diabetes , type 1 diabetes , closed loop , series (stratigraphy) , medicine , diabetes mellitus , blood glucose self monitoring , computer science , intensive care medicine , continuous glucose monitoring , endocrinology , engineering , gastric emptying , biology , control engineering , stomach , paleontology
Background: Gastroparesis is associated with unpredictable gastric emptying and can lead to erratic glucose profiles and negative impacts on quality-of-life. Many people with gastroparesis are unable to meet glycemic targets and there is a need for new approaches for this population. Hybrid closed-loop systems improve glucose control and quality-of-life but evidence for their use in people with diabetic gastroparesis is limited. Methods: We present a narrative review of the challenges associated with type 1 diabetes management for people with gastroparesis and present a case series of 7 people with type 1 diabetes and gastroparesis. We compare glycemic control before and during the first 12 months of hybrid closed-loop therapy. Data were analyzed using electronic patient records and glucose management platforms. We also discuss future advancements for closed-loop systems that may benefit this population. Results: Five of 7 patients had data available for time in range before and during hybrid closed-loop therapy, and all had an improvement in percentage time in target glucose range, with the overall mean time in range increasing from 26.0% ± 15.7% to 58.4% ± 8.6% during HCL use, ( P = .004). There were significant reductions in HbA1c (83 ± 9 mmol/mol to 71 ± 14 mmol/mol) and mean glucose from 13.0 ± 1.7 mmol/L (234 ± 31 mg/dL) to 10.0 ± 0.7 mmol/L (180 ± 13 mg/dL) with use of a hybrid closed-loop system. Importantly, this was achieved without an increase in time in hypoglycemia ( P = .50). Conclusion: Hybrid closed-loop systems may represent a valuable approach to improve glycemic control for people with type 1 diabetes and gastroparesis. Prospective studies are required to confirm these findings.