Closing the loop for those with sub-optimal glycaemic control

Dr Mary Abraham is a paediatric endocrinologist and a clinical researcher based at Perth Children's Hospital / Telethon Kids Institute, leading the technology research theme in the Children’s Diabetes Centre. Her Raine Fellowship examined novel methods to assist adolescents with sub-optimal glycaemic control, aiming to improve their management of diabetes and mitigate associated risks.

Individuals with Type 1 diabetes (T1D) with persistently high glucose levels are at increased risk of developing diabetes complications. This burden of chronic disease can negatively impact the individual, the family and health care system. Hence, it is vital to devise interventions to improve glycaemic control and potentially reduce the burden of chronic disease.

Automated pump therapy improves glucose levels in people with T1D. However, clinical trials have shown these results in individuals with optimal glycaemic control. Individuals struggling with diabetes care are historically not recruited in these trials, the very group most likely to benefit from these technologies. Therefore, the objective was to utilize an automated insulin delivery (hybrid closed loop or HCL) system to improve glycaemic control for adolescents struggling with diabetes care. Dr Abraham conducted a 6-month multi-centre clinical trial, studying the effect of HCL in 46 adolescents with poor glycaemic control and comparing this with standard care.

At the end of 6-months, blood glucose was reduced in those with HCL as compared to standard care.

HCL also reduced hyperglycaemia and hypoglycaemia. Overall, an improvement in glycaemic control was noted in participants with suboptimal glycaemic control during the 6-month trial.

11 publications including 3 first authored publications were produced during the fellowship in some of the highest quality journals including JAMA Pediatrics, Pediatric Diabetes and Diabetes Technology and Therapeutics among others. The work changed clinical practice at the institution where the project was conducted establishing a clinical pathway for roll-out. This approach was also adopted across other paediatric diabetes centres in Australia.

Dr Abraham explained that, "The 3-year fellowship provided me the opportunity to have protected research time as an early career researcher. This was extremely valuable as it enabled me to work on my project in a timely fashion and allowed me to seek further funding opportunities to work on future projects. Through this I was able to complete a substantial research project, including the multicentre randomized clinical trial. This body of work will help improve the scientific evidence in this field and advocate towards improving the health care of youth struggling with their diabetes care. Furthermore, the fellowship enabled me to apply for grants, commence new studies, continue and complete other existing studies. I was able to acquire further research funding to continue my work."