Glycemic control by treatment modalities: national registry-based population data in children and adolescents with type 1 diabetes

AIMSTo assess the differences in key parameters of type 1 diabetes (T1D) control associated with treatment and monitoring modalities including newly introduced hybrid closed-loop (HCL) algorithm in children and adolescents with T1D (CwD) using the data from the population-wide pediatric diabetes registry CENDA. MATERIALS AND METHODSCwD younger than 19 years with T1D duration > 1 year were included and divided according to the treatment modality and type of CGM used: multiple daily injection (MDI), insulin pump without (CSII) and with HCL function, intermittently scanned continuous glucose monitoring (isCGM), real-time CGM (rtCGM), and intermittent or no CGM (noCGM). HbA1c, times in glycemic ranges, and glucose risk index (GRI) were compared between the groups.RESULTSData of a total of 3251 children (mean age 13.4 +/- years) were analyzed. 2187 (67.3%) were treated with MDI, 1064 (32.7%) with insulin pump, 585/1064 (55%) with HCL. The HCL users achieved the highest median TIR 75.4% (IQR 6.3), and GRI 29.1 (7.8), both p<0.001 compared to other groups, followed by MDI rtCGM and CSII groups with TIR 68.8% (IQR 9.0) and 69.0% (7.5), GRI 38.8 (12.5) and 40.1 (8.5), respectively (non-significant to each other). These three groups did not significantly differ in their HbA1c medians (51.8 (IQR 4.5), 50.7 (4.5), and 52.7 (5.7) mmol/mol, respectively). NoCGM groups had the highest HbA1c and GRI and lowest TIR regardless of the treatment modality.CONCLUSIONSThis population-based study shows that the HCL technology is superior to other treatment modalities in CGM-derived parameters and should be considered as a treatment of choice in all CwD fulfilling the indication criteria.