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Keywords: Type 1 diabetes; Pregnancy; aHCL; CGM metrics EN Type 1 diabetes Pregnancy aHCL CGM metrics 516 518 3 07/07/23 20230701 NES 230701 To the Editor: The achievement of strict glycemic control during pregnancy in women with type 1 diabetes (T1D) is essential to prevent pregnancy-related complications (such as congenital malformation, pre-eclampsia, and preterm delivery) and to reduce the risk of delivering infants large for gestational age (LGA).[1] Although continuous glucose monitoring (CGM) can help reaching targeted glucose levels,[2] only a minority of pregnant women achieved the glycemic and HbA SB 1c sb targets recommended by international guidelines.[3] In recent years, the introduction of closed-loop insulin delivery systems has allowed a significant improvement in glycemic control in subjects with TID. The use of the aHCL system may improve CGM metrics in pregnant women with long-lasting T1D unwilling to stop aHCL therapy during pregnancy or with an unsatisfactory glycemic control with other insulin therapies. [Extracted from the article]

Aim: To evaluate the long-term efficacy, up to 2 years, of an advanced hybrid closed-loop (AHCL) system and to assess predictors of best results of the therapy. Methods: We retrospectively evaluated 296 adults with type 1 diabetes mellitus [mean age 42.8 ± 16.5 years, men 42.9%, duration of diabetes 22.5 ± 12.8 years, body mass index 24.9 ± 4.7 kg/m2, baseline glycated hemoglobin (HbA1c) 63.4 ± 12.2 mmol/mol (8.0 ± 1.1%) ] who used the MiniMed™ 780G system. Demographic and clinical data were recorded. Continuous glucose monitoring (CGM)-derived metrics and insulin requirement were analyzed from the 4 weeks before and from every quarter after the switch to the AHCL system. Results: In the first quarter of AHCL treatment, all CGM metrics improved. Time in range (TIR) increased from 58.1 ± 17.5% to 70.3 ± 9.5% (P < 0.0001). The improvement lasted for up to 2 years of observation regardless of previous insulin therapies. Throughout the period of observation, 53.4% of participants achieved mean TIR >70%, 92.6% mean time below range <4%, and 46% mean glucose management indicator <53 mmol/mol (7.0%). At univariable logistic regression older age, lower baseline HbA1c and insulin requirement were associated with mean TIR >70%. At multivariable analysis, lower HbA1c remained independently associated with a better glycemic control. However, mean TIR increased more in participants with a higher baseline HbA1c. Conclusions: Switching to an AHCL leads to a rapid improvement in glycemic control lasting for up to 24 months along with a low risk for hypoglycemia, confirming the safety of the system. Lower baseline HbA1c was the main predictor of better efficacy of therapy, although higher baseline HbA1c was associated with the greatest improvement in mean TIR. [ABSTRACT FROM AUTHOR]