Temporary Target Versus Suspended Insulin Infusion in Patients with Type 1 Diabetes Using the MiniMed 780G Advanced Closed-Loop Hybrid System During Aerobic Exercise: A Randomized Crossover Clinical Trial

<b><i>Aim:</i></b> To compare the safety in terms of hypoglycemic events and continuous glucose monitoring (CGM) metrics during aerobic exercise (AE) of using temporary target (TT) versus suspension of insulin infusion (SII) in adults with type 1 diabetes (T1D) using advanced hybrid closed-loop systems. <b><i>Methods:</i></b> This was a randomized crossover clinical trial. Two moderate-intensity AE sessions were performed, one with TT and one with SII. Hypoglycemic events and CGM metrics were analyzed during the immediate (baseline to 59 min), early (60 min to 6 h), and late (6 to 36 h) post-exercise phases. <b><i>Results:</i></b> In total, 33 patients were analyzed (44.6 ± 13.8 years), basal time in range (%TIR 70-180 mg/dL) was 79.4 ± 12%, and time below range (%TBR) <70 mg/dL was 1.8 ± 1.7% and %TBR <54 mg/dL was 0.5 ± 0.9%. No difference was found in the number of hypoglycemic events, %TBR <70 mg/dL and %TBR <54 mg/dL between TT and SII. Differences were found in the early phase, with better values when using TT for %TIR 70-180 mg/dL (83.0 vs. 65.3, <i>P</i> = 0.005), time in tight range (%TITR 70-140 mg/dL) (56.3 vs. 41.5, <i>P</i> = 0.04), and time above range (%TAR >180 mg/dL) (15.3 vs. 31.8, <i>P</i> = 0.01). In the diurnal period, again %TIR was better for TT use (82.1 vs. 73.1, <i>P</i> = 0.02) and %TAR (15.0 vs. 22.96, <i>P</i> = 0.04). No significant differences were found in the CGM metrics during the different phases of AE. <b><i>Conclusion:</i></b> Our data appear to show that the use of TT compared with SII is equally safe in all phases of AE. However, the use of TT allows for a better glycemic profile in the early phase of exercise.