Does Age Matter? A Look at Control-IQ Technology Outcomes

In my work writing and advocating for people with diabetes, I have met many fellow companions along the journey – from parents of a newly-diagnosed two-year-old, to people living with diabetes for more than 60 years.

We might share a diagnosis, but our experiences are so different. And as we move through life, our relationships with diabetes evolve depending on the challenges, responsibilities, milestones, access, and support we have.

When I think about new diabetes technology, drugs, or other strategies, I want to know the answer to a vitally important question: How well does this work at different ages?

As a close follower of the field since 2010, this has always been one of the most compelling aspects of closed-loop technology – it helps level the diabetes playing field.

This article looks at some of the outcomes from three Control-IQ® technology studies, filtering them by age.^1-3 How consistent is this predictive technology on the t:slim X2™ insulin pump from Tandem Diabetes Care? Can it help people who are young, middle-aged, and later in life?

Sensor Time in Range

The main studies of Control-IQ technology tested closed loop in two broad age groups: 14-71 years old and 6-13 years old. Both studies, published in the prestigious The New England Journal of Medicine, had a parallel control group (for simplicity I’m excluding those control groups here).^1,2

Users wore a Tandem Diabetes Care® insulin pump and Dexcom G6 continuous glucose monitoring (CGM) system at the start of the study (Baseline), allowing researchers to measure sensor time in range before turning on Control-IQ technology (Closed Loop). The gray bars in the chart below show sensor time in range – percent within 70-180 mg/dL – for different age groups in the studies. At Baseline, it was 51%-55% in the three youngest age groups and 66% in those 25-71 years. Again, this was Open-Loop use – manual diabetes management with a pump and CGM.

After turning on the Control-IQ technology advanced hybrid closed-loop system and using it for four to six months, users in every age group saw their sensor time in range increase. Closed Loop added a consistent 10-to-14 percentage points to sensor time in range, equivalent to an additional two to three hours per day in range. It’s an impressively consistent pattern.

Only Closed-Loop group baseline data is shown. Supplementary Tables S7 and S6 (respectively).^1,2

The outcomes above were seen in controlled research studies. But what about real-world use? This exact question was examined in a newer study of 1,435 Control-IQ technology users.   

Participants were 14 years or older, had to have uploaded data to t:connect® web application, and had to have used Control-IQ technology for at least three weeks. In the chart below, you’ll notice similar – and in some cases slightly better – sensor time in range outcomes in a wide range of ages:

Only Time Point 2 is shown.³

So far, this gives me confidence that Control-IQ technology benefits a wide spectrum of ages, driving strong and consistent sensor time in range improvements in both controlled and real-world studies. 

Hypoglycemia

Here’s what the data looks like for hypoglycemia – percent time below 70 mg/dL – in the two main studies. At Baseline, before turning on Closed Loop, hypoglycemia was relatively low in all age groups:

After turning on Closed Loop and using it for four to six months, time in hypoglycemia improved in three age groups and was maintained at a very low level in 11-to-14 year olds:

Only Closed-Loop group baseline data is shown. Supplementary Tables S7 and S7 (respectively).^1,2

Do these hypoglycemia outcomes hold up in real-world data? Indeed they do. In that same study of 1,435 Control-IQ technology users, time below 70 mg/dL was also recorded. Every age group saw low rates of hypoglycemia (below 1.5%) in real-world Control-IQ technology use, with outcomes similar to, or even slightly better than, the controlled studies discussed above.

Only Time Point 2 is shown.³

Imagine yourself at 6 years old and 71 years old, trying your best to live with type 1 diabetes. What is similar at those ages? What is different?  

These three studies included people with diabetes along that wide age spectrum – all using the exact same technology. In all three studies, we saw quite encouraging data, including consistent and similar sensor time in range and hypoglycemia outcomes. In a disease that is so unpredictable, and so tied to the patterns of life, it is refreshing to have something consistent.

From time to time, we may pass along suggestions, tips, or information about other Tandem insulin pump user experiences or approaches to the management of diabetes. Please note, however, individual symptoms, situations, circumstances, and results may vary. Please consult your physician or qualified healthcare provider regarding your condition and appropriate medical treatment. Please read the Important Safety Information before using a Tandem Diabetes Care product. 

References:

1. Brown SA, Kovatchev BP, Raghinaru D, et al. Six-month randomized, multicenter trial of closed-loop control in type 1 diabetes. N Eng J Med. 2019;381(18):1701-1717. doi: 10.1056/NEJMoa1907863.
2. Breton MD, Kanapka L, Beck RW, et al. A randomized trial of closed-loop control in children with type 1 diabetes. N Eng J Med. 2020;383:836-845. doi: 10.1056/NEJMoa2004736.
3. Breton MD, Kovatchev BP. One year real-world use of the Control-IQ advanced hybrid closed-loop technology. Diabetes Technol Ther. 2021;ahead of print. doi: 10.1089/dia.2021.0097

Responsible Use Control-IQ Technology

Even with advanced systems such as the t:slim X2 insulin pump with Control-IQ technology, users are still responsible for actively managing their diabetes. Control-IQ technology does not prevent all high and low blood glucose events. The system is designed to help reduce glucose variability, but it requires that users accurately input information, such as meals and periods of sleep or exercise. Control-IQ technology will not function as intended unless all system components, including CGM, infusion sets and pump cartridges, are used as instructed. Importantly, the system cannot adjust insulin dosing if the pump is not receiving CGM readings. Since there are situations and emergencies that the system may not be capable of identifying or addressing, users should always pay attention to their symptoms and treat accordingly.