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Type 1 diabetes patients who used either an insulin pump or who continuously monitored their glucose levels or regularly conducted both tests, successfully achieved lower hemoglobin A1c (HbA1c) test results and had fewer episodes of diabetic ketoacidosis, shows a new study published in Diabetes Care. Researchers also found that patients who used insulin pumps had lower rates of severe hypoglycemia.
Although different insulin analogs, pumps, and sensors have been proven to work, studies have shown that few children and adolescents achieve recommended HbA1c targets. “In pediatric populations, use of pumps and continuous glucose monitor devices vary across health care delivery contexts internationally, and substantial differences have been observed in HbA1c outcomes,” wrote authors who were led by Craig Jefferies, MBCHB, a pediatric endocrinologist in Auckland, New Zealand.
In this study, researchers, examined insulin delivery and glucose monitor methods in a large group of juvenile patients from the Better Control in Pediatric and Adolescent Diabetes: Working to Create Centers of Reference (SWEET) registry.
The study sample included 25,654 type 1 diabetes patients between 1-18 years old who had used an insulin pump or continuous glucose monitor sensor between August 2017–July 2019. The patients were divided into four groups: Injections with no sensor (37.44%); injections with a sensor (14.98%); the use of a pump, but no sensor (17.22%); and, the use of pump with a sensor (30.35%).
For those patients who used a pump and/or a continuous glucose monitor sensor, their HbA1c was lower as compared to patients who used injections with no sensor treatment. For patients who used pumps and sensors, or those who used pumps without sensors, there were fewer reported episodes of diabetic ketoacidosis (1.98%; 95% CI 1.64–2.48; P < 0.001) (and, 2.02%; 95% CI 1.64–2.48; P < 0.05) when compared with patients who had injections or sensors (2.91%; 95% CI 2.59–3.31).
There were fewer cases of severe hypoglycemia in the group who used pumps with sensors (1.10%; 95% CI 0.85–1.43; P < 0.001), but there were more cases in the group that used injections and sensors (4.25%; 95% CI 3.65–4.95; P < 0.001) as compared to the group that used injections, but no sensors (2.35%; 95% CI 2.04–2.71).
“In conclusion, we found that children and adolescents in SWEET centers who use a pump or/and sensor to manage diabetes have a lower HbA1c and fewer episodes of DKA. Also, pump users experience a lower rate of SH episodes. Our findings show a major evolution in technology use over the past 10 years and a progressive improvement in the attaining of glycemic targets globally,” the authors wrote.
Limitations associated with this study included not including the proportion of participants within the category of pump 1 sensor that were using advanced features of the system (e.g., hybrid closed loop). The sample was not sufficient enough to establish comparisons as a single group, authors wrote.
Disclosures: This research was funded by corporate sponsors Abbott, Boehringer Ingelheim, Dexcom, Insulet, Eli Lilly and Company, Medtronic, and Sanofi.
Reference
Roque Cardona-Hernandez, Anke Schwandt, Hessa Alkandari, Heiko Bratke, et al. “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,” Diabetes Care. March 2021. doi.org/10.2337/dc20-1674
