Temporary Target versus Suspended Insulin Infusion in Patients with Type 1 Diabetes Using the MiniMed 780G Advanced Closed-Loop Hybrid System During Aerobic Exercise. Randomized crossover clinical trial.

Abstract

To compare the safety and continuous glucose monitoring (CGM) metrics during aerobic exercise (AE) of using temporary target (TT) versus (vs.) suspension of insulin infusion (SII) in adults with type 1 diabetes (T1D) using advanced hybrid closed-loop systems. Randomized crossover clinical trial. Two moderate-intensity AE sessions were performed, one with TT and one with SII. Hypoglycemic events and CGM metrics were analyzed during the immediate (baseline and 59 minutes), early (60 minutes to 6 hours), and late (6 to 36 hours) post-exercise phases. 33 patients were analyzed (44.6±13.8 years, 52% male, time in range (%TIR 70-180 mg/dL) 79.4 ± 12%, time below range (%TBR) <70 and <54 mg/dL was 1.8±1.7% and 0.5±0.9%, respectively). Differences were found between TT vs. SII use in the early phase for %TIR 70-180 mg/dL (83.0 vs. 65.3,p=0.005), time in tight range (%TITR 70-140mg/dL) (56.3 vs. 41.5,p=0.04) and time above range (%TAR>180mg/dL) (15.3 vs. 31.8,p=0.01). No significant differences were found in the CGM metrics during the different phases of physical activity. When evaluating the diurnal period, %TIR was higher for TT use (82.1 vs. 73.1,p=0.02) and %TAR was higher for SII (15.0 vs. 22.96,p=0.04), with no difference in the number of hypoglycemic events or changes in time below range (%TBR) <70 and <54 mg/dL. The use of TT compared to SII is equally safe in the immediate, early and late phases of AE. However, the use of TT allows a better glycemic profile to be achieved in the early phase of exercise.