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Glycemic Control in Relation to Technology Use in a Single-Center Cohort of Children with Type 1 Diabetes

Alexandra Sawyer1, Marisa Sobczak2, Gregory P Forlenza3

  • 1Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.

Diabetes Technology & Therapeutics
|January 31, 2022
PubMed

Insights

Continuous glucose monitoring (CGM) and insulin pumps significantly improve glycemic control in type 1 diabetes (T1D) patients. Hybrid closed-loop (HCL) systems further lower hemoglobin A1c (HbA1c) levels, but disparities in technology access exist.

Area of Science:

  • Pediatric Endocrinology
  • Diabetes Technology
  • Clinical Research

Background:

  • Technological advancements in type 1 diabetes (T1D) management, including continuous glucose monitoring (CGM) and insulin pumps, are increasingly adopted by pediatric populations.
  • These technologies have the potential to significantly impact glycemic control.

Purpose of the Study:

  • To evaluate the utilization of T1D technologies (CGM, insulin pumps, hybrid closed-loop systems) in a pediatric cohort.
  • To assess the impact of these technologies on glycemic control, measured by hemoglobin A1c (HbA1c).

Main Methods:

  • Retrospective analysis of 4003 T1D patients (<22 years old) at the Barbara Davis Center (Jan 2018-Dec 2020).
  • Patients were categorized by technology use: multiple daily injection/blood glucose meter (MDI/BGM), pump/BGM, MDI/CGM, and pump/CGM.
  • Glycemic control (HbA1c) was compared using ANCOVA, controlling for diabetes duration, race, and insurance.

Main Results:

  • Pump/CGM users (49.8%) had the lowest mean HbA1c (8.1%), followed by MDI/CGM users (15.4%, HbA1c 8.6%).
  • Both MDI/CGM and pump/CGM users achieved significantly lower HbA1c levels compared to MDI/BGM users (P < 0.0001).
  • Hybrid closed-loop (HCL) technology within pump/CGM users was associated with the lowest HbA1c (7.6%) and higher rates of achieving HbA1c < 7.0% (P < 0.001).

Conclusions:

  • CGM use is associated with improved glycemic control in both MDI and pump users.
  • Insulin pump use demonstrates a significant benefit for glycemic control only when combined with CGM.
  • Hybrid closed-loop systems offer the most significant glycemic benefits, but disparities in access based on language and race/ethnicity require attention to reduce inequities in T1D care.

Keywords:
Continuous glucose monitoringInsulin pumpsPediatricsType 1 diabetes

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