Assessing the efficacy of a hybrid closed loop system in a racial-ethnic minority cohort of children and adolescents with type 1 diabetes

Andrea Granados; Juliana Orrego Castellanos; Andrea Martinez Sanchez; Maria Jose Giraldo; Adriana Carrillo-Iregui

doi:10.1515/jpem-2024-0535

Article

Assessing the efficacy of a hybrid closed loop system in a racial-ethnic minority cohort of children and adolescents with type 1 diabetes

Andrea Granados , Juliana Orrego Castellanos , Andrea Martinez Sanchez , Maria Jose Giraldo and Adriana Carrillo-Iregui

Published/Copyright: February 17, 2025

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From the journal Journal of Pediatric Endocrinology and Metabolism Volume 38 Issue 4

Abstract

Objectives

Despite improved outcomes in the use of a hybrid closed loop system (HCLS), significant disparities in the application of this technology exist among youth with type 1 diabetes (T1DM). The study aimed to evaluate the impact of a tubeless HCLS on glycemic outcomes in a pediatric racial-ethnic minority population.

Methods

A retrospective, single-center study included youth with T1D initiating HCLS Omnipod 5. Outcomes included HbA1c, continuous glucose monitor variables, BMI Z score, and episodes of diabetic ketoacidosis (DKA). Outcomes were compared from baseline, 3 and 6 months of Omnipod 5 start.

Results

The study included 174 participants, aged between 2 and 22 years, with a mean age of 7.9 ± 3.7 years. Hispanics constituted 87.3 % (152) of the cohort, with 53 % males and 47 % females. Insurance coverage was 56.9 % public, 42.5 % private, and 0.5 % uninsured. Baseline HbA1c level was 8.0 % ± 1.7, 7.3 % ± 1.1 at 3 months and 7.3 % ± 1.1 at 6 months (p<0.001). Glucose time in range (TIR) was 54.5 % at baseline to 61.9 % at 3 months, and 60.5 % at 6 months (p<0.001). Notably, there were no changes in BMI z-scores or DKA episodes following the initiation of the HCLS Omnipod 5.

Conclusions

The study showed that a tubeless HCLS significantly improved glycemic control in a pediatric minority cohort with T1DM, without affecting BMI Z-scores or increasing DKA episodes. Ongoing efforts to address disparities in diabetes technology access are crucial for optimizing care and alleviating the burden on individuals with T1DM across racial backgrounds.

Keywords: type 1 diabetes; diabetes mellitus; hybrid closed loop system; insulin pumps; minority; technology

Corresponding author: Andrea Granados, MD, Department of Pediatric Endocrinology and Diabetes, Nicklaus Children’s Hospital, 3100 SW 62 Av., Suite 102, Miami, FL 33155, USA, E-mail: andrea.granados@nickllaushealth.org

The manuscript has been presented to the Endocrine Society Conference Abstract section. Boston MA. USA. June 1st 2024.

Acknowledgments

We would like to express our deepest gratitude to all the patients who participated in this study. Their willingness to contribute their time and experiences was invaluable to our research. We also extend our heartfelt thanks to the entire diabetes team, including the endocrinologists, diabetes educators, nurses, and support staff, for their unwavering dedication and expertise.

Research ethics: Endocrinology umbrella 1-1249983 Approved in January of 2020.
Informed consent: Consent not required.
Author contributions: AC and AG contributed to the conception and design of the work. AC, AG, AM, JO and MG contributed to the acquisition of data for the work. AC, AG, AM contributed to the analysis of the data. AC, AG, AM, JO and MG contributed to the interpretation of data. AC, AG, AM, JO and MG drafted the manuscript, and all authors critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript.
Use of Large Language Models, AI and Machine Learning Tools: None declared.
Conflict of interest: The authors state no conflict of interest.
Research funding: None declared.
Data availability: Not applicable.

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Received: 2024-11-06

Accepted: 2025-01-23

Published Online: 2025-02-17

Published in Print: 2025-04-28

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Articles in the same Issue

https://doi.org/10.1515/jpem-2024-0535

Keywords for this article

type 1 diabetes; diabetes mellitus; hybrid closed loop system; insulin pumps; minority; technology