Abstract
Background: This study evaluated the use of the Medtronic MiniMed 670G system in adults with type 1 diabetes mellitus from a large endocrinology practice and its impact on glycemic control, quality of life (QoL), compliance and safety. Methods: 84 participants completed one site visit for data collection. Percentage of time in range (TIR: 70–180 mg/dL), hyperglycemia (>180 mg/dL), hypoglycemia (<70 mg/dL), HbA1c, average blood glucose (ABG), and other metrics were evaluated at the last visit using the system (LVMM) and compared between the last visit on previous insulin therapy (LVPT). Participants completed three questionnaires to assess QoL. Continuation of the auto mode feature was determined to assess compliance. Results: The mean percentage of TIR at the LVPT was 46.26 ± 18.82% while that at the LVMM was 73.39 ± 12.95%. This represents a significant increase in percentage of TIR of 27.13% (p < 0.001). The mean percentage of time in hyperglycemia at the LVPT was 47.42 ± 20.39% while that at the LVMM was 23.51 ± 11.65%, representing a significant decrease of 23.90% (p < 0.001). The mean percentage of time in hypoglycemia at the LVPT was 6.17 ± 7.91% while that at the LVMM was 2.94 ± 4.72%, representing a significant decrease of 3.22% (p = 0.004). The mean HbA1c at the LVPT was 7.36 ± 1.03% (57 mmol/mol) while that at the LVMM was 7.45 ± 0.85% (58 mmol/mol), representing an increase of 0.09% (p = 0.337). For those with HbA1c greater than or equal to 7.5% at LVPT, the mean HbA1c at the LVPT was 8.49 ± 0.78% (69 mmol/mol) while that at the LVMM was 8.00 ± 0.85% (64 mmol/mol), representing a significant decrease of 0.48% (p = 0.007). For those with HbA1c less than 7.5% at LVPT, the mean HbA1c at the LVPT was 6.78 ± 0.53% (51 mmol/mol) while that at the LVMM was 7.16 ± 0.69% (55 mmol/mol), representing a significant increase of 0.38% (p< 0.001). Patients with LVPT HbA1c less than 7.5% (58 mmol/mol) had a significant reduction in hypoglycemia (<70 mg/dL) from 7.40% to 2.56% (p = 0.001), whereas the reduction in patients with LVPT HbA1c greater than or equal to 7.5% (58 mmol/mol) was from 4.11% to 3.59% (p = 0.758). QoL questionnaires revealed good satisfaction with the system and 86% of participants continued use in auto mode. Conclusions: The use of the Medtronic MiniMed 670G system resulted in a TIR above the recommended target and a significant increase in the percentage of TIR compared to previous insulin therapy. While there was no significant change in HbA1c in the overall population, those with higher HbA1c values at baseline had a reduced percentage of time in hyperglycemia, while those with lower HbA1c values had a reduced percentage of time in hypoglycemia, indicating improvement in parameters specific to each subgroup. The system may be a reasonable choice for patients struggling with significant amounts of hypoglycemia. Use of the system resulted in a high degree of patient satisfaction and excellent compliance in the use of the system.
Measuring spatial price differentials at the basic heading level: a comparison of stochastic index number methods
