TOPLINE:
Hybrid closed-loop (HCL) systems may ease severe diabetes distress in some adults with type 1 diabetes (T1D), but not in adolescents.
METHODOLOGY:
- Previous findings suggest a 20%-30% prevalence of severe diabetes distress in patients with T1D, which affects self-care, diabetes management, glycemic control, and quality of life (QoL).
- IMPLIQUE, a quality-of-life study, assessed the HCL system in 250 adults (mean age, 42.4 years; 58.4% women) and adolescents (mean age, 15.1 years; 54.5% women) with T1D from 55 French centers.
- All patients had been using an insulin pump and a continuous glucose monitoring system for at least 6 months. The HCL system was activated at the end of a 3-week run-in period.
- The participants completed questionnaires assessing diabetes-related distress (Problem Areas in Diabetes [PAID]-20 or PAID-5) and QoL (Audit of Diabetes-Dependent Quality-of-Life [ADDQoL]), as well as others for stress, anxiety, depression, fatigue, and fear of hypoglycemia.
- The primary outcomes were the PAID and ADDQoL scores assessed at baseline, 3 months, and 6 months during the study period.
TAKEAWAY:
- At baseline, 64% of adults had a PAID score above 40 indicating severe diabetes distress, which dropped to 50% at 6 months.
- In adults, the PAID score decreased after 3 months of HCL system use and remained stable at 6 months, for a 16% mean improvement.
- The ADDQoL global score showed rapid improvement among adults in the first 3 months of HCL system use and remained stable at 6 months.
- Adolescents in the study started with lower levels of diabetes distress than adults and had no change in PAID and ADDQoL scores, but they increased their physical activity level.
- The fear of hypoglycemia (Hypoglycemia Fear Survey including the behavior) improved significantly in both adults (P < .001) and adolescents (P < .05) after 6 months.
IN PRACTICE:
While HCL improved several psychosocial outcomes, residual risk remained, prompting the authors to note, "The high percentage of residual distress despite HCL use suggests unmet needs, which should be handled in an alternative way with psychotherapeutic approaches."
SOURCE:
The study, led by Yves Reznik, MD, Endocrinology and Diabetes Department, CHU Côte de Nacre, Caen Cedex, France, was published online in Diabetes Obesity and Metabolism.
LIMITATIONS:
The study lacked a comparative control group.
DISCLOSURES:
The study was funded by VitalAire. Many of the authors declared receiving consultant/speaker fees, research support, and lecturer/scientific advisor fees from various sources including VitalAire and other medical device, pharmaceutical, and diabetes care companies.