Closed-loop control improved percent time in range compared to open loop (71.3% vs. 64.7%; difference +6.6%, 95% CI 1-12; P=0.005) in adolescents with T1D during a 5-day ski camp.
RCT (n=32)
Coarsely paired by age and hemoglobin A1c
Yes
Does a closed-loop control system improve glycemic control in adolescents with type 1 diabetes during intense prolonged outdoor exercise?
Closed-loop control systems safely improve glycemic control and reduce hypoglycemia in adolescents with type 1 diabetes during intense, prolonged winter sports.
Mean Difference: 6.6 (95% CI 1–12)
Absolute Event Rate: 71.3% vs 64.7%
p-value: p=0.005
OBJECTIVE Intense exercise is a major challenge to the management of type 1 diabetes (T1D). Closed-loop control (CLC) systems (artificial pancreas) improve glycemic control during limited intensity and short duration of physical activity (PA). However, CLC has not been tested during extended vigorous outdoor exercise common among adolescents. RESEARCH DESIGN AND METHODS Skiing presents unique metabolic challenges: intense prolonged PA, cold, altitude, and stress/fear/excitement. In a randomized controlled trial, 32 adolescents with T1D (ages 10–16 years) participated in a 5-day ski camp (∼5 h skiing/day) at two sites: Wintergreen, VA, and Breckenridge, CO. Participants were randomized to the University of Virginia CLC system or remotely monitored sensor-augmented pump (RM-SAP). The CLC and RM-SAP groups were coarsely paired by age and hemoglobin A1c (HbA1c). All subjects were remotely monitored 24 h per day by the study physicians and clinical team. RESULTS Compared with physician-monitored open loop, percent time in range (70–180 mg/dL) improved using CLC: 71.3 vs. 64.7% (+6.6% 95% CI 1–12; P = 0.005), with maximum effect late at night. Hypoglycemia exposure and carbohydrate treatments were improved overall (P = 0.001 and P = 0.007) and during the daytime with strong ski level effects (P = 0.0001 and P = 0.006); ski/snowboard proficiency was balanced between groups but with a very strong site effect: naive in Virginia and experienced in Colorado. There was no adverse event associated with CLC; the participants’ feedback was overwhelmingly positive. CONCLUSIONS CLC in adolescents with T1D improved glycemic control and reduced exposure to hypoglycemia during prolonged intensive winter sport activities, despite the added challenges of cold and altitude.
Breton et al. (Wed,) conducted a rct in Type 1 diabetes (n=32). Closed-loop control (CLC) system vs. Remotely monitored sensor-augmented pump (RM-SAP) / physician-monitored open loop was evaluated on Percent time in range (70-180 mg/dL) (MD 6.6, 95% CI 1-12, p=0.005). Closed-loop control improved percent time in range compared to open loop (71.3% vs. 64.7%; difference +6.6%, 95% CI 1-12; P=0.005) in adolescents with T1D during a 5-day ski camp.