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A decade of improved glycemic control in young children with type 1 diabetes: A population-based cohort study

Frida Sundberg1,2, Jonatan Nåtman3, Stefan Franzen3,4

  • 1Division of Pediatrics, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.

Pediatric Diabetes
|April 10, 2021
PubMed

Insights

Continuous glucose monitoring (CGM) and insulin pump use significantly increased in children with type 1 diabetes (T1D) between 2008 and 2018, leading to lower HbA1c levels. However, cardiovascular risks persist due to elevated HbA1c and unchanged overweight/obesity rates.

Area of Science:

  • Pediatrics
  • Endocrinology
  • Metabolic Diseases

Background:

  • Early-onset type 1 diabetes (T1D) carries a high risk of cardiovascular complications and premature death.
  • HbA1c and overweight are significant modifiable risk factors for T1D complications.
  • Continuous glucose monitoring (CGM) has emerged as a key technological advancement in T1D management.

Purpose of the Study:

  • To compare treatment outcomes in children under 7 years old with T1D in Sweden.
  • To analyze data from two distinct cohorts in 2008 and 2018 to assess changes in management and outcomes.

Main Methods:

  • Utilized data from the national pediatric diabetes registry (SWEDIABKIDS) for children under 7 with T1D.
  • Analyzed data from cohorts in 2008 and 2018, comparing key clinical indicators and treatment modalities.

Main Results:

  • The use of CGM increased from 0% to 98%, and insulin pump use rose from 40% to 82% between 2008 and 2018.
  • Mean HbA1c levels decreased significantly from 58 mmol/mol (7.4%) to 50 mmol/mol (6.7%) (p < 0.01).
  • The prevalence of overweight and obesity remained stable at approximately 26-29% in both cohorts.

Conclusions:

  • Increased adoption of CGM and insulin pumps correlated with improved glycemic control (lower HbA1c) in young T1D patients.
  • Despite improvements, HbA1c levels remain above physiological targets, posing ongoing cardiovascular risk, particularly when combined with overweight or obesity.
  • The unchanged prevalence of overweight and obesity highlights a persistent challenge in managing T1D complications in this pediatric population.
Abstract

Keywords:
HbA1coverweightpreschooltype 1 diabetes

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