Glycemic Outcome Associated With Insulin Pump and Glucose Sensor Use in Children and Adolescents With Type 1 Diabetes. Data From the International Pediatric Registry SWEET

Version 2 2021-03-03, 00:12

Version 1 2021-03-02, 17:28

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posted on 2021-03-03, 00:12 authored by Roque Cardona-Hernandez, Anke Schwandt, Hessa Alkandari, Heiko Bratke, Agata Chobot, Nicole Coles, Sarah Corathers, Damla Goksen, Peter Goss, Zineb Imane, Katrin Nagl, Stephen M.P. O´Riordan, Craig Jefferies, the SWEET Study Group

OBJECTIVE

This study aims to examine insulin delivery methods, glucose monitoring modalities and related outcomes in a large, international, diverse cohort of children and adolescents with type 1 diabetes from the SWEET-Registry

RESEARCH DESIGN AND METHODS

Participants with type 1 diabetes of >1 year of duration, aged ≤18y and documented pump/sensor usage during the period August 2017-July 2019 were stratified into four categories: injections-no sensor (reference); injections+sensor; pump-no sensor; pump+sensor. HbA_1c and proportion of patients with DKA or SH were analyzed; linear and logistic regression models adjusted for demographics, region and gross-domestic-product (GDP)-per capita were applied.

RESULTS

Data of 25,654 subjects were analyzed. Injections-no sensor: 37.44% [adjusted-HbA_1c 8.72 (95%CI 8.68-8.75)]; injections+sensor: 14.98% [adjusted-HbA_1c 8.30 (8.25-8.35)]; pump-no sensor: 17.22% [adjusted-HbA_1c 8.07 (8.03-8.12)]; pump+sensor: 30.35% [adjusted-HbA_1c 7.81 (7.77-7.84)]. HbA_1c was lower in all categories of subjects using pump and/or sensor compared to injections-no sensor treatment method (p<0.001, respectively). Proportion of DKA episodes was lower in subjects with pump+sensor [1.98 (1.64-2.48); p<0.001] and pump-no sensor [2.02 (1.64-2.48); p<0.05)] when compared to injections-no sensor [2.91 (2.59-3.31)]. Proportion of SH was lower in pump-no sensor [1.10 (0.85-1.43); p<0.001] but higher in the injections+sensor [4.25 (3.65-4.95); p<0.001] compared to injections-no sensor [2.35 (2.04-2.71)].

CONCLUSIONS

Lower HbA_1c and fewer DKA episodes were observed in subjects using either a pump, CGM or both. Pump use was associated with lower rate of SH. Across SWEET centers, use of pumps and CGM is increasing. The concomitant use of pump and CGM was found to be associated with an additive benefit.