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

Abstract

OBJECTIVE Insulin delivery methods, glucose-monitoring modalities, and related outcomes were examined in a large, international, diverse cohort of children and adolescents with type 1 diabetes from the Better Control in Pediatric and Adolescent Diabetes: Working to Create Centers of Reference (SWEET) registry. RESEARCH DESIGN AND METHODS Participants with type 1 diabetes of $1 year duration, aged #18 years, and who had documented pump or sensor usage during the period August 2017–July 2019 were stratified into four categories: injections–no sensor (reference); injections + sensor; pump–no sensor; and pump + sensor. HbA1c and proportion of patients with diabetic ketoacidosis (DKA) or severe hypoglycemia (SH) were analyzed; linear and logistic regression models adjusted for demographics, region, and gross domestic product per capita were applied. RESULTS Data of 25,654 participants were analyzed. The proportions of participants (adjusted HbA1c data) by study group were as follows: injections–no sensor group, 37.44% (8.72%; 95% CI 8.68–8.75); injections + sensor group, 14.98% (8.30%; 95% CI 8.25–8.35); pump–no sensor group, 17.22% (8.07%; 95% CI 8.03–8.12); and pump + sensor group, 30.35% (7.81%; 95% CI 7.77–7.84). HbA1c was lower in all categories of participants who used a pump and/or sensor compared with the injections–no sensor treatment method (P < 0.001). The proportion of DKA episodes was lower in participants in the pump + sensor (1.98%; 95% CI 1.64–2.48; P < 0.001) and the pump–no sensor (2.02%; 95% CI 1.64–2.48; P < 0.05) groups when compared with those in the injections–no sensor group (2.91%; 95% CI 2.59–3.31). The proportion of participants experiencing SH was lower in pump–no sensor group (1.10%; 95% CI 0.85–1.43; P < 0.001) but higher in the injections + sensor group (4.25%; 95% CI 3.65–4.95; P < 0.001) compared with the injections–no sensor group (2.35%; 95% CI 2.04–2.71). CONCLUSIONS Lower HbA1c and fewer DKA episodes were observed in participants using either a pump or continuous glucose monitoring (CGM) or both. Pump use was associated with a lower rate of SH. Across SWEET centers, use of pumps and CGM is increasing. The concomitant use of pump and CGM was associated with an additive benefit.