Comparison of the night-time effectiveness in achieving glycemic targets in adults with type 1 diabetes of three advanced hybryd closed-loop systems

Context: Advanced hybrid closed loop (AHCL) systems currently represent the most advanced modality of insulin therapy. Aim: To compare the night-time (from 00 to 07 a.m.) effectiveness in achieving recommended glycemic targets of three different AHCL systems in adults with type 1 diabetes (T1D). Methods: We retrospectively evaluated 55 adults with T1D (mean age 41 ± 16 years, male 40%, diabetes duration 19.4 ± 11.4 years, BMI 24.1 ± 4.1 kg/m2) with similar glycemic control (GMI 7.0-7.4%). Twenty-two participants were using the Minimed 780G system, 18 the Tandem t:slim X2 with Control-IQ system and 15 the DBLG1 system. Continuous glucose monitoring derived metrics and insulin requirement of 14 consecutive nights were analyzed. Results: All three groups achieved the recommended mean TIR > 70%, mean TBR < 4%, and mean CV < 36% with a similar insulin requirement (Minimed 780G system: TIR 73.9 ± 11.2%, TBR 0.9 ± 1.2%, CV 29 ± 6.7%; Tandem t:slim X2 with Control-IQ system: TIR 74.1 ± 11.1%, TBR 1.1 ± 1.0%, CV 34.5 ± 6.6%; DBLG1 System TIR 71.7 ± 11.3%, TBR 1.4 ± 3.7%, CV 32.4 ± 7.1%). Tight TIR% (70-140 mg/dl) was significantly higher (p < 0.01) in the Tandem t:slim X2 with Control-IQ group (51.5 ± 9.8%) when compared to Minimed 780G group (42.1 ± 13.7%) and DBLG1 System (40.1 ± 10.5%). In all three groups the insulin infusion similarly decreased from midnight to 05.00 am and then increased. Conclusions: All the three AHCL systems achieved the recommended TIR, TBR and CV without difference in insulin requirement. The Tandem Control-IQ system obtained a higher tight TIR.