by Amy Sanghavi Shah, MD, MS

The FLAIR trial showed that the MiniMed Advanced Hybrid Closed-Loop (AHCL) system improved daytime hyperglycemia and glycemic control compared to the currently approved 670G system. The upgraded system, MiniMed 780G, uses a control algorithm based on that in the 670G system, but adds the ability to set different glucose targets and incorporates automatic correction boluses from the logic algorithm.

The FLAIR study directly compared the two systems in a randomized crossover design, making it the first trial to have a commercially available closed-loop system as a comparator. A total of 111 adolescents and young adults (ages 14–29 years) with type 1 diabetes (T1D) used the systems over two 12-week periods in a randomly assigned order.

A significant 3% reduction in time over 180 mg/dL was observed among patients using the AHCL and was not associated with increased hypoglycemia. Average time in range was 63% with 670G and 67% with AHCL, respectively. Additionally, the improvements were seen regardless of whether or not participants had used diabetes technologies prior to enrollment. This is significant, since prior use of technology is often an entry requirement for clinical trials involving closed-loop systems. Patients also reported significantly more satisfaction with the new AHCL system over 670G.

Adolescents and young adults with T1D often have a difficult time achieving good glucose control, which is important in reducing the risk for diabetes-related complications. Despite the use of multiple daily injections or insulin pumps and glucose sensors, there is still a need for many individuals to further improve glucose levels without causing hypoglycemia or adding to the daily burden of living with diabetes. The autocorrection feature may be an advantage for adolescents and young adults, and others. There is much interest in the future of advanced technology to treat T1D. The AHCL system is a significant step forward