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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

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posted on 03.03.2021, 00:12 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. HbA1c 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-HbA1c 8.72 (95%CI 8.68-8.75)]; injections+sensor: 14.98% [adjusted-HbA1c 8.30 (8.25-8.35)]; pump-no sensor: 17.22% [adjusted-HbA1c 8.07 (8.03-8.12)]; pump+sensor: 30.35% [adjusted-HbA1c 7.81 (7.77-7.84)]. HbA1c 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 HbA1c 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.

Funding

This work was supported by the SWEET corporate members, namely: Abbott, Boehringer Ingelheim, Dexcom, Insulet, Lilly, Medtronic, and Sanofi. The content is solely the responsibility of the authors and does not necessarily represent the official views of the corporate members. We are thankful for the following individuals for their support of this work: Katharina Fink and Anke Schwandt for the data management as well as Andreas Hungele and Ramona Ranz for the DPV software (all Ulm University, Germany), Michael Witsch (Centre Hospitalier de Luxembourg, Luxembourg) for center integration, Thomas Danne and Olga Kordonouri (Kinder- und Jugendkrankenhaus AUF DER BULT, Hannover, Germany) for initiating the SWEET collaboration, Katharina Klee (Kinder- und Jugendkrankenhaus AUF DER BULT, Hannover, Germany) and Reinhard Holl (Ulm University, Germany) for their invaluable support. Finally, we would like to thank all participating centers of the SWEET network, especially the collaboration centers in this investigation (Appendix).

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