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In This Issue of Diabetes Care

A subanalysis of the pivotal trial of Medtronic’s MiniMed 670G hybrid closed-loop insulin management system reveals a series of insights and teaching points on how the system performs with adolescents and young adults with type 1 diabetes. According to Messer et al. (p. 789), 31 participants age 14–26 years were included in the analysis. In line with the original study design, the participants had a 2-week run-in (baseline) period with the system running in open-loop mode, followed by 3 months with hybrid closedloop mode activated. Data were then compared between baseline and the closed-loop period at 1 week and at 1, 2, and 3 months. They report that after 3 months with the system in fully automatic mode, participants experienced a 14% increase in time in range, a mean decrease in HbA1c of 0.75%, and no overall changes in the amount of dosed insulin. Carbohydrate-to-insulin ratios were more aggressive in comparison to the run-in period when the system was in open-loop setting. However, time in Auto Mode did gradually decline from 87% to a fi nal rate of 72% over the 3-month study period. The researchers report that the primary reasons for exiting Auto Mode were system-initiated events where the set-up entered Safe Basal Mode or where overt hyperglycemia occurred where the system required manual intervention to correct insulin dosing. Much less common, however, were user-initiated exits from Auto Mode. Author Laurel H. Messer told Diabetes Care: “Our intent with this subanalysis was to bring clinically useful information on hybrid closed-loop therapy to the forefront as carbohydrate-to-insulin ratios make an appreciable difference. Seventy percent time in range correlated approximately with seventy-fi ve percent hybrid closed-loop use. These are tangible pearls that clinicians can leverage with their patients. We are just scratching the surface of useful information for hybrid closed-loop systems, and ongoing evaluation of system characteristics will be essential for current and future automated insulin delivery systems.”