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[Sensor-Augmented Pump Therapy: description of pediatric patients with Type 1 Diabetes Mellitus (T1D) and initial
Carolina Wong Lam1, Josefa Hurtado Navarro2, Rocío Fuentes Díaz2
1Hospital San Juan de Dios, Santiago, Chile.
Insights
The insulin microinfuser system (SAPT) improved hypoglycemia management and HbA1c in type 1 Diabetes Mellitus (T1D) pediatric patients. While Time In Range (TIR) increased, it did not reach target levels within the first year.
Area of Science:
- Endocrinology and Metabolism
- Pediatric Endocrinology
- Biomedical Engineering
Context:
- Type 1 Diabetes Mellitus (T1D) requires intensive management, often involving advanced insulin delivery systems.
- The insulin microinfuser with integrated system (SAPT) is a high-cost treatment now included in national health systems.
- Understanding the real-world outcomes of SAPT in pediatric T1D is crucial for optimizing patient care.
Purpose:
- To evaluate the initial and first-year metabolic outcomes of pediatric T1D patients using SAPT.
- To describe the epidemiological and nutritional characteristics of this patient cohort.
- To assess the effectiveness of SAPT in managing glycemic control and hypoglycemia.
Summary:
- A retrospective study analyzed 12 pediatric T1D patients using SAPT over 12 months.
- Key outcomes included Total Daily Dose (TDD), %Basal (%B), Time In Range (TIR), Time Below Range (TBR), and HbA1c.
- Median HbA1c was 7.7% at 12 months, with a favorable increase in TIR (39%) and a low TBR (1%).
Impact:
- SAPT demonstrated effectiveness in hypoglycemia management and contributed to HbA1c improvement in pediatric T1D.
- Increased TDD and %B approached physiological requirements, potentially due to predictive suspension and Continuous Glucose Monitoring (CGM).
- While TIR showed improvement, further observation is needed to reach target ranges, considering patient and clinical team learning curves.
Abstract:
The insulin microinfuser with integrated system (SAPT) for patients with type 1 Diabetes Mellitus (T1D) is included in the national financial protection system for high-cost treatments.
Objective:
To describe the initial and first-year metabolic outcomes and epidemiological and nutritional characteristics of T1D pediatric patients treated with SAPT.
Patients And Method:
Retrospective, descriptive and analytical study of clinical records from 2017 to 2019, of 12 patients with T1D users of SAPT, attended in a referral hospital.
Variables:
age at program entry, time of evolution of the disease, type of insulin treatment and type of glucose monitoring (capillary: sample or Continuous Glucose Monitoring [CGM]) at program entry, cause of application to the program, nutritional status, rural or urban origin, educational level of the main guardian, HbA1c at application and in the last month of each quarter after SAPT installation, over a 12-month period. HbA1c analysis was venous sample by High-Performance Liquid Chromatography and follow-up was capillary sample by Latex Particle Agglutination Inhibition.
Results:
The median variables at 12 months of treatment were Total Daily Dose (TDD) 0.74, %Basal (%B) 49%, Time In Range (TIR) 39%, Time Below Range (TBR) 1%, and HbA1c 7.7%. The sensor usage time was met in all cases and only half of them achieved a correct execution of hyperglycemia and hypoglycemia treatment. Inadvertent severe hypoglycemia was the main cause of application to the program.
Conclusion:
TDD and %B increased, approaching physiological requirement, although without statistical significance, which could be attributed to the administra tion of adequate insulin with lower risk of hypoglycemia due to predictive suspension and CGM. TIR presented a favorable increase, although not significant, nor reaching the target range, attributable to the short observation time, difficulties in understanding and execution of our patients, and the learning process of the treating clinical team. SAPT was effective in hypoglycemia management and effective in improving HbA1c.
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