Does Combining a Mobile Dose Calculation App with a Continuous Insulin Infusion System Improve Glycemic Control and Quality of Life Compared with a Hybrid System in Patients with Type 1 Diabetes? A Descriptive Open-Label Sequential Study

Abstract

Introduction: Achieving optimal glycemic control in patients with type 1 diabetes mellitus (PwT1DM) is essential to prevent complications. Continuous subcutaneous insulin infusion (CSII) systems combined with continuous glucose monitoring (CGM) have improved outcomes, but the effectiveness of additional technologies, such as mobile apps and hybrid closed-loop systems (HCLSs), remains unclear. This study evaluates glycemic control and quality of life (QoL) in adult PwT1DM transitioning from multiple daily injections (MDI) to a CSII, first with the Mylife? Dose app and subsequently switching to an HCLS. Materials and Methods: This was a 10-month, multicenter, open-label sequential study involving 135 adults with type 1 diabetes (T1D), all of whom were using isCGM and MDI before transitioning to CSII, first with the Mylife Dose app and later to an HCLS. Glycemic control (glycated hemoglobin [HbA1c], time in range [TIR], time below range, time above range), insulin requirements, and QoL/treatment satisfaction/hypoglycemia perception (Diabetes Quality of Life questionnaire, Diabetes Treatment Satisfaction Questionnaire, Clarke's test) were measured at each of the four study visits. Results: Transitioning from MDI to CSII showed modest improvements in HbA1c (7.57%-7.42%; P = 0.02) and TIR (56.3%-60.4%; P < 0.01). The introduction of the Mylife Dose app did not provide significant additional improvements in glycemic control or QoL, although it provided an additional tool for diabetes management. However, switching to an HCLS resulted in substantial improvements in HbA1c (6.7%), TIR (73.1%), and QoL, with over 70% of patients achieving an HbA1c <7%. Insulin requirements increased slightly with the HCLS, primarily due to basal insulin. Adherence was high, with 88.1% completing the study. Conclusions: The Mylife Dose app does not improve glycemic control or QoL significantly but offers convenience for patients with T1D. In contrast, HCLSs provide significant metabolic and QoL benefits, supporting their integration into T1D management with appropriate reimbursement policies.