Insulin Pump Improves Glycemic Control but Increases Fat in Type 1 Diabetes

Insulin pumps and glucose monitoring systems have improved type 1 diabetes care in children and adolescents but may bring other health issues. Researchers investigated this interaction.

In children and adolescents with type 1 diabetes (T1D), those who switched from multiple daily injections to an insulin pump showed significant improvement in glycemic control but increased body adiposity over time, according to study findings published in Pediatric Diabetes.

The study was an analysis of data from the prospective, multicenter SWEET (Better control in Pediatric and Adolescent diabeteS: Working to crEate CEnTers of Reference) diabetes patient registry. In total, researchers evaluated 4643 patients with T1D between 2 and 18 years of age with a diabetes duration of ≥1 year. The investigators collected data for the group in 2016 (median age, 11.6 years; median diabetes duration, 3.4 years) and 2019 (median age, 14.6 years; median diabetes duration, 6.3 years).

In the analysis, the investigators used glycated hemoglobin (HbA1c) to measure metabolic control, while the body mass index (BMI) standard deviation score (BMI-SDS) was used to assess body adiposity. Patients were classified according to treatment modality, including those who received multiple daily insulin injections (MDI) and those who used a continuous subcutaneous insulin infusion (CSII) pump. Researchers evaluated differences in HbA1c and BMI-SDS between patient groups.

From 2016 to 2019, there were significant increases in the proportion of patients that used multiple daily injections (MDI) with continuous glucose monitoring (CGM) (7.2% to 25.7%, respectively; P <.001) and insulin pump technology with CGM (7.8% to 27.8% respectively; P <.001). In linear regression models adjusted for age and sex, as well as diabetes duration and region, the investigators found significantly lower HbA1c levels in patients who switched from MDI to CSII pump technology, with or without CGM (P <.001). In contrast, the investigators observed a higher BMI-SDS in patients who switched from MDI without CGM to insulin pump with CGM (P <.05) and from MDI without CGM to insulin pump without CGM (P <.01).

Limitations of the study included the lack of data on participants’ ethnic backgrounds, socioeconomic disparities in accessing diabetes technology, physical activity history, or dietary patterns.

The investigators concluded that their findings “emphasize the role of diabetes technology in improving glucose control in [a] pediatric population with T1D but also the need for developing further strategies to prevent excess fat accumulation such as improved education programs on nutrition habits and mealtime routines”.

Disclosure: This clinical trial was supported by Abbott, Boehringer Ingelheim, Eli Lilly, Sanofi and other private industries. Please see the original reference for a full list of disclosures.


Marigliano M, Eckert AJ, Guness PK, et al. Association of the use of diabetes technology with HbA1c and BMI-SDS in an international cohort of children and adolescents with type 1 diabetes: The SWEET project experience. Pediatr Diabetes. Published online October 30, 2021. doi:10.1111/pedi.13274