6452 Hybrid Closed Loop Insulin Pump Therapy (Omnipod-5, T-Slimx2, Medtronic 780G) in uncontrolled type 1 Diabetes previously treated with multiple daily injections or open loop pumps

Abstract Disclosure: I. Farhat: None. S. Drishti: None. R. Bargman: None. Background: Type 1 diabetes mellitus (T1DM) poses significant challenges in managing blood glucose levels, especially in adolescents and those from lower socioeconomic backgrounds. Hybrid closed-loop insulin pump systems (HCL) integrating continuous glucose monitoring (CGM) and insulin infusion have shown promise in improving glycemic control in well-controlled patients the utility of these systems is unknown in poorly controlled populations. Objectives: This study aimed to assess real-world glycemic outcomes in children, adolescents, and young adults with uncontrolled T1DM (baseline HbA1c > 9%) using HCL pump systems (Omnipod 5, Tandem t: slim X2, Medtronic 780G) after at least one year on multiple daily injections (MDI) or open loop continuous subcutaneous insulin infusion (CSI) by the impact on HbA1c levels. Methods: Descriptive, retrospective chart review within the NYCHHC hospital system (public hospital system of New York City), of patients aged 3-24 years with T1DM for at least one year. Data on HbA1c, demographics, BMI, emergency room visits, and hospital admissions were collected from the electronic medical records. Statistical analysis using paired T-tests, compared pre-HCL and post-HCL (more than 6 months) periods. Results: A cohort of 66 patients (33 males, 33 females), with average age of16 years were identified. 19 were Hispanic, 32 were Black or African American, and 15 belonged to other racial backgrounds. Baseline average A1C was 10.9. 53 patients were prescribed Omnipod-5, 12 T-slimX2, and 1 Medtronic 780G. Of these individuals, 52 started and stayed on the pump, 14 had not commenced treatment, and 5 patients discontinued the pump system prior to the end of the study. The median follows up period was 10 months and a significant improvement in glycemic control was observed with HbA1c which decreased from 10.9 (pre-HCL initiation) to 9.8 (post-HCL) (p=0.0001, 95% CI: 0.5458-1.5558). Breaking down the group into those who persisted with HCL and those who did not, it is notable that for those who discontinued HCL HbA1c levels increased not significantly from 11.6 to 12.0, (p=0.6144, 95% CI: -2.2042 to 1.4802) while in 46 patients who continued using HCL, HbA1c decreased significantly from 10.7 to 9.5 (p=0.0001, 95% CI: 0.6818-1.7337). Patients who hadn't yet initiated pump treatment displayed an average A1c of 11.9 prior to the prescription and had no further A1C measurements during the study period. Conclusion: The study demonstrates partial efficacy of HCL pump systems in improving glycemic control in individuals with poorly controlled T1DM but fails to achieve good or moderate control. This improvement could potentially reduce long term complications but further improvements are needed to bring this population’s control into target range. Presentation: 6/2/2024