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OBJECTIVEWe aimed to compare glucose control in adolescents with type 1 diabetes (T1D) using the MiniMed 780G system who used simplified meal announcement with those who used precise carbohydrate counting.RESEARCH DESIGN AND METHODSThis randomized controlled trial included 34 participants (age 12–18 years) with T1D who were on multiple daily injections or insulin pump and were scheduled to start using the MiniMed 780G system at Sidra Medicine in Qatar. After a 7-day run-in period, participants were randomly assigned to the fix group (simplified meal announcement by preset of three personalized fixed carbohydrate amounts) or the flex group (precise carbohydrate counting) and followed for 12 weeks. Between-group difference in time in range (TIR) was the primary end point. Secondary end points included HbA1c and other glycometrics.RESULTSDuring the 12-week study phase, TIR was 73.5 ± 6.7% in the fix and 80.3 ± 7.4% in the flex group, with a between-group difference of 6.8% in favor of flex (P = 0.043). Time >250 mg/dL was better in the flex group (P = 0.012), whereas HbA1c (P = 0.168), time below range (P = 0.283), and time between 180 and 250 mg/dL (P = 0.114) did not differ.CONCLUSIONSAdolescents using the MiniMed 780G system with a preset of three personalized fixed carbohydrate amounts can reach international targets of glycemic control. Therefore, it may be a valuable alternative to precise carbohydrate counting in users who are challenged by precise carbohydrate counting. Because carbohydrate counting further improves outcomes, these skills remain important for MiniMed 780G users.

Background: The objective of this study was to evaluate glycemic outcomes using a structured initiation protocol for Hybrid Closed Loop (HCL) MiniMed 670G and Advanced Hybrid Closed Loop (AHCL) Minimed 780G system in children and adolescents with Type 1 Diabetes (T1D) previously treated with Multiple Daily Injections. Methods: The data from two separate (HCL and AHCL system) investigations were analyzed in individuals (aged 7-18 years) with T1D on MDI therapy, both followed a structured initiation protocol. Time in Ranges, HbA1c and system characteristics were analyzed between two systems at 3 and 6 months of Automated Insulin Delivery (AID) . Results: 30 children (age 10.24 ± 2.6 years, HbA1c 8.2±1.4% (66±15.3 mmol/mol)) with HCL system and 34 children (12.5 ± 3.7 years, 8.6±1.7% (70±18.6 mmol/mol)) with AHCL system completed the planned 12 weeks of AID. TIR (70-180mg/dl) of 73.4±8.9% with HCL and 78.2±4.3% with AHCL (p=0.01) was achieved at 6 months of AID. No episodes of severe hypoglycemia or DKA were reported using both systems. Conclusion: Individuals using AHCL MiniMed 780G system had more stringent system settings, spent more time in AID with less exits, which possibly lead to further improvements of glycemic control compared to HCL MiniMed 670G system using the same structured protocol. Disclosure G.Petrovski: None. J.Campbell: Advisory Panel; Medtronic. F.Alkhalaf: None. K.Hussain: None.

Introduction: The COVID-19 pandemic forced health authorities to issue restrictive measures on daily activities from March 12th to June 15th, 2020 (‘lockdown’) in Qatar, which may have influenced the glycemic control in patients with type 1 diabetes (T1D). The aims of the study was to evaluate glycemic control between Multiple Daily Injections (MDI) and Hybrid Closed Loop (HCL) system in children and adolescent with T1D during the lockdown. Methods: This single-center analysis included 168 patients with T1D, using MDI or HCL system MiniMed 670G (Medtronic, Northridge, USA) at least 3 months before the study. Glycemic control from face-to-face visits, three months before lockdown were analyzed and compared to face to face or remote visits during the lockdown of 3 months. Data was collected through the electronic medical record system and reports generated by Carelink Therapy Management Software. HbA1c, glucose and insulin data were analyzed before and 3 months after restrictions. Results: Patients were analyzed in two groups: 1) 92 patients (age 12.4±3.1 years, female:51) on MDI and 2) 76 patients (age 11.2±2.6 years, female:36) HCL system. HbA1c in patients on MDI increased from 8.3±1.5% (67±16.4 mmol/mol) before lockdown to 8.9±1.7% (74±18.6 mmol/mol) during the lockdown, compared to patients on HCL system, where HbA1c remained stable (7.0±0.9% (53±9.8 mmol/mol) to 7.1±1.2% (54±13.1mmol/mol) respectively). No significant difference on DKA events were found in MDI group, before and after lockdown, while no DKA was noted in HCL group during the study. No severe hypoglycemia was observed in both groups. Remote visits were 54% in patients on HCL system, compared to 38% in patients on MDI during the lockdown. Conclusion: Children and adolescents using HCL system maintained stabile glycemic control during the lockdown compared to patient on MDI, where the glycemic control deteriorated. Disclosure G. Petrovski: None. J. Campbell: None. K. Hussain: None. Alkhalaf and consultants/educators: n/a.

Background: Advanced Hybrid Closed Loop (AHCL) systems provide superior glycemic control in children and adolescents with Type 1 Diabetes (T1D). Current studies included participants with previous pump and Continuous Glucose Monitoring (CGM) experience. We aimed to study transitioning these patients on Multiple Daily Injections (MDI) without prior pump experience to AHCL systems within a short period, utilizing a structured initiation protocol and the glycemic control they achieved with the MiniMed 780G system. Methods: In this prospective open label single-arm, single-center, clinical investigation, we recruited children and adolescents (aged 7-17 years) with T1D on MDI therapy and HbA1c below 12.5% from Sidra Medicine (Doha, Qatar). All participants followed a structured initiation protocol including 4 steps: step 1: AHCL system assessment (1 hour discussion with educator); step 2: AHCL system training (2-hours sessions in 4 consecutive days with groups of 2 to 3 participants and caregivers); step 3: SAP use for 3 days; step 4: AHCL system use for 12 weeks, cumulating in 10 days from MDI to AHCL initiation. The primary outcome of the study was the change in the time spent in the target in range (TIR) of 70-180 mg/dl and HbA1c from baseline (MDI + CGM, 1 week) to study phase (AHCL, 12 weeks). This study is registered with ClinicalTrials.gov, number NCT04308291, and is completed. Findings: Between October 25, 2020, and February 5, 2021, 34 participants were recruited and all of them completed the 12 weeks study. TIR increased from 42.1±18.7% at baseline to 78.8±6.1% in the study phase ( p 70% and a HbA1c of

Due to the coronavirus disease 2019 restrictions in providing diabetes services, we have developed an innovative pump training program, which consisted of technical session, pump training, one in-person practical session, and four consecutive online sessions (Skype Meet Now). A 13-year-old female patient with a 4-year history of type 1 diabetes (T1D) on multiple daily injections (MDI) with glycated hemoglobin 8.9%; 74 mmol/mol) initiated Minimed 670G system using the program. Time in range (70-180 mg/dL) of 39% and sensor glucose (SG) of 214±91 mg/dL (MDI with continuous glucose monitoring) increased to 69% in the first 2 weeks and reached 86% and SG of 140±40 mg/dL in the first month of auto mode initiation, without severe hypoglycemia or hyperglycemia. Virtual pump training program can be an effective tool to initiate a hybrid closed-loop system and to improve glycemic control in people with T1D on MDI.

Objective To evaluate the effect of a 1-year hybrid closed-loop (HCL) system on glycemic control in children and adolescents with type 1 diabetes (T1D) previously treated with multiple daily injections (MDI). Methods This was a 1-year observational study, as a continuation of the previous 3 months prospective study of pediatric patients with T1D conducted at Sidra Medicine in Qatar. The study enrolled individuals aged 7–18 years with T1D > 1 year, on MDI with self-monitoring of blood glucose or continuous glucose monitoring, with no prior pump experience, and with an HbA1c level

Aim: Evaluation of six months experience on MiniMed 670G Hybrid Closed Loop (HCL) system in patients with type 1 diabetes (T1D), previously treated with Multiple Daily Injections (MDI). Methods: This is a 6-months prospective observational study of patients (7 to 18 years) with T1D on MDI, starting the MiniMed 670G system, using a 10-day initiation protocol: 2-days, HCL system assessment; 5-days, HCL system training (2-hours sessions in 5 consecutive days); 3-days, Manual Mode use of HCL system and 6 months, Auto Mode use of the HCL system. Results: MiniMed 670G was initiated in 47 patients (age 12.2±3.2 years). All patients used the system for six months period. Auto Mode usage was 87.2% at the first month and 89.6% at the 6-months of Auto Mode initiation. The mean HbA1c decreased from 8.4±1.5% (68±16.4 mmol/mol) at baseline, 6.7±0.8% (50±8.7 mmol/mol) at 3-months (p=0.021), to 6.9±0.7% (52±7.7 mmol/mol) at 6-months of MiniMed 670G initiation (p=0.024). Time in Range (70-180mg/dL) significantly increased over the time (Figure 1). No severe hypoglycemia nor DKA were found. Conclusion: Children and adolescents with T1D can successfully initiate the HCL system, achieve and maintain better glycemic control than previous MDI regimen. Low attrition rate and the sustainability of the results are likely due to patients’ selection, structured educational program and HCL system by itself. Disclosure G. Petrovski: None. J. Campbell: None. F. AlKhalaf: None. F. Umer: None. K. Hussain: None.

Aim To describe continuous subcutaneous insulin infusion (CSII) characteristics in type 1 diabetes mellitus (T1DM) children and adolescents using a standardized protocol in routine clinical settings in Qatar. Methods A total of 138 T1DM patients (62 males; 76 females; mean age 9.8 ± 3.4 years) with a mean diabetes duration of 2.4 ± 1.9 years initiated CSII (MiniMed® Veo®™ and MiniMed® 640 G insulin pumps; Medtronic, Northridge, CA, USA) in 2016 and 2017. CSII characteristics and glycated hemoglobin (HbA1c) were evaluated 1 year after treatment initiation. Results At 1 year after treatment initiation, the insulin dose had significantly increased (from 0.59 ± 0.23 to 0.74 ± 0.26 U/kg body weight per 24; P

Aim The aim of this study was to evaluate the 10-day initiation protocol for MiniMed 670G hybrid closed-loop (HCL) system in individuals with type 1 diabetes on multiple daily injection (MDI) in achieving desirable glycemic control. Methods An open-label single-arm, single-center, clinical investigation in children aged 7–18 years on MDI following a structured protocol: 2 days, HCL system assessment; 5 days, HCL system training (2-h sessions on 5 consecutive days with groups of 3–5 participants and families); 3 days, Manual Mode use of HCL system; 84 days, Auto Mode use of the HCL system, cumulating in 10 days from MDI to Auto Mode activation. Results A total of 30 children (age 10.24 ± 2.6 years) were enrolled in the study, and all completed the planned 84 days on Auto Mode. The participants used the sensor for a median of 92% of the time and spent a median of 89% in Auto Mode. The mean HbA1c decreased from 8.2 ± 1.4% (66 ± 15.3 mmol/mol) at baseline to 6.7 ± 0.5% (50 ± 5.5 mmol/mol) at the end of the study (p = 0.017). Time in range (70–180 mg/dL) increased from 46.9 ± 18.5% at baseline to 75.6 ± 6.9% in Auto Mode (p

We present the optimization of a hybrid closed-loop (HCL) insulin pump system in a type 1 diabetes (T1D) patient in the first 3 months of using the Minimed 670G. An 11-year-old female with 7 years of T1D history started using the Minimed 670G HCL system at our center. The patient had been using the Medtronic Veo insulin pump without a sensor for almost 4 years with HbA1c levels between 7.8% and 10.2%. We introduced the Minimed 670G to improve overall glucose control, improve quality of life and lessen the diabetes burden. Insulin pump characteristics of the Minimed Veo pump were used as the initial setting in the HCL system. The optimization of the Minimed 670G in the next 3 months led to the following changes: an insulin-to-carbohydrate ratio (ICHR) from 1 to 10 g in the morning period (6 a.m. to 12 a.m.) and 15-12 g for the rest of the day (12 p.m. to 6 a.m.); an active insulin time from 4 to 3 h and insulin sensitivity factor (ISF) from 120 to 90 mg/dl with no change in target range. The HbA1c level decreased by - 1.3%, and the time in range significantly increased to 77% with SG values of 139 ± 60 mg/dl, sensor wear of 82% and an auto mode period of 84% per week. Health providers should consider immediate adjustment of the bolus wizard settings such as the ICHR, ISF and active insulin time. The HCL system can improve overall glucose control with increased time in the range of sensor glucose values and reduction of HbA1c levels.

Objectives Brucellosis is one of the most common zoonoses worldwide. Most cases in the United States occur among travelers or immigrants from endemic regions, mostly Central America. In this study, we aimed at describing and comparing the epidemiology and clinical presentation of brucellosis in pediatric and adult patients at two large tertiary care centers in Houston, Texas. Methods We identified patients diagnosed as having brucellosis between January 2000 and December 2009 by searching electronic medical records and reviewing microbiology records for positive cultures. Cases were defined as those with a positive blood culture for Brucella sp, a serum agglutination titer ≥1:80 (or both positive blood culture and serum agglutination titer ≥1:80), along with an epidemiologic risk factor and clinical presentation that is consistent with brucellosis. Results Six adult and 12 pediatric cases were identified; 13 of 18 (72%) cases were immigrants, mostly from Central America. The median ages for adult and pediatric patients were 53 and 3 years old, respectively. Ingestion of unpasteurized milk products was frequently reported. Common clinical features included fever (83%), arthralgias or arthritis (67%), and hepatosplenomegaly (61%). Positive blood cultures were more frequently reported among children than adults (83% vs 33%, P = 0.03). The most common laboratory finding was mildly elevated transaminases. Three adults (50%) but no children developed thrombocytopenia (P = 0.02). Relapsed infection was a frequent occurrence. Conclusions In the southern United States, brucellosis is an important consideration in the differential diagnosis of immigrants presenting with undifferentiated fever and joint complaints. A careful history often reveals an epidemiologic risk factor such as ingestion of unpasteurized dairy products.

Background Higher 25(OH)D3 levels are associated with lower HbA1c, but there are limited UK interventional trials assessing the effect of cholecalciferol on HbA1c. Aims (1) To assess the baseline 25(OH)D3 status in a Manchester cohort of children with type 1 diabetes (T1D). (2) To determine the effect of cholecalciferol administration on HbA1c. Methods Children with T1D attending routine clinic appointments over three months in late winter/early spring had blood samples taken with consent. Participants with a 25(OH)D3 level 10 years) units. HbA1c levels before and after treatment were recorded. Results Vitamin D levels were obtained from 51 children. 35 were Caucasian, 11 South Asian and 5 from other ethnic groups. 42 were vitamin D deficient, but 2 were excluded from the analysis. All South Asian children were vitamin D deficient, with mean 25(OH)D3 of 28 nmol/L. In Caucasians, there was a negative relationship between baseline 25(OH)D3 level and HbA1c (r = −0.484, P t = 1.010, P = 0.328) or at 1 year (t = −1.173, P = 0.248) before and after treatment. One-way ANCOVA, controlling for age, gender, ethnicity, BMI and diabetes duration showed no difference in Δ HbA1c level. Conclusion We report important findings at baseline, but in children treated with a stat dose of cholecalciferol, there was no effect on HbA1c. Further studies with larger sample sizes and using maintenance therapy are required.

Background Extreme variation in provider nutritional practices in the NICU leads to poor growth of premature infants. Standardization of current feeding practices through quality improvement may improve growth trajectory and developmental outcomes. Objectives Increase the mean delta Z score for weight (difference in z-score between birth weight and discharge weight) from −1.8 to −1 within 6 months and sustain for 1 year, for neonates with birth weight (BW) Methods A multidisciplinary team evaluated nutrition practices for VLBW infants and key drivers were determined (figure 1). Re-education around our current feeding protocol and intolerance decision aid, sharing growth information during rounds using an in-house assessment tool (figure 2), increased accessibility to breast pump rentals, standardization of lactation consultation ordering, and development of an infographic to assist mothers in choosing breast milk over formula (figure 3) were interventions tested using the IHI Model for Improvement. Mean delta Z score for weight (primary outcome measure) and number of lactation consultation orders per week (process measure) were recorded and analyzed. Results Mean delta weight Z-score increased from −1.8 to −1.08 (figure 4) following the implementation of all of the noted interventions with centerline shift that has lasted for 8 months (40% improvement). Mean number of lactation consults ordered per week increased from 1 to 4. Conclusions Reducing nutrition practice variation shows marked improvements in infant nutrition status. We continue to test other interventions with the hope of further decreasing growth failure.