Simplified meal management in adults using an advanced hybrid close loop system.

Background The advanced hybrid closed loop (AHCL) algorithm combines automated basal rates and corrections yet requires meal announcement for optimal performance, which poses a challenge for some. We aimed to compare glucose control in adults with T1D using the MiniMedTM 780G AHCL system utilizing simplified meal announcement versus precise carbohydrate counting. Methods In a study involving 14 adults with T1D, we evaluated glycemic control during a 13 week "precise phase", followed by two 3-4 week simplified meal announcement phases: "universal" (preset of one personalized fixed carbohydrate amount) and "incremental" (entry of multiples of one, two, or three of these presets depending on meal size estimate). Results Mean age was 45.7±12.4 and ten participants were male (71%). Mean baseline HbA1c was 6.8%±1.2% and TIR 67.5%±16.7%. Comparing the universal to the precise study phase, TIR was similar (75.4±13% vs. 77.7±9%, p=0.12) and GMI was slightly higher (6.8±0.4 vs. 6.6±0, p=0.01). Furthermore, there was less level 1 and 2 hypoglycemia (1.6±1% vs. 2.8±2%, p=0.03 and 0.3±5% vs. 0.65±1%, p=0.08), but slightly more level 1 and 2 hyperglycemia (17.1±8% vs. 15.0±7%, p=0.05 and 5.5±5% vs. 3.6±3%, p=0.04). When comparing the incremental to the precise phase, GMI was identical (6.6%) and TIR superior (80.5±10% vs. 77.7±9%, p=0.02). Additionally, there was less level 1 hypoglycemia (1.9±1% vs. 2.8±2%, p=0.01) and a trend for less level 2 hypoglycemia (0.4±0.7% vs. 0.65±1%, p=0.08). Conclusions A simplified meal announcement strategy in adults using the MiniMedTM780G system, relying on three increments of a universal CHO amount, may offer a way to improve glycemic control and ease self-care. For patients with more limitations, using one universal CHO amount could be a safe alternative meeting most consensus glycemic targets.