Differences in Achieving Stringent Glycemic Targets Among Youth with Type 1 Diabetes: A SWEET Registry Study

This study aimed to investigate the associations between glycemic outcomes and a range of clinical and demographic factors, including treatment modality, sex, age, diabetes duration, and body mass index, in youth with type 1 diabetes in an international registry.

This observational, cross-sectional cohort study included youth <21 years from 23 countries. Proportions of individuals using different treatment modalities (continuous glucose monitoring [CGM] with injections, CGM with pump, automated insulin delivery [AID]) and achieving recommended time in tight range (TITR >50%), time in range (TIR >70%), and glycated hemoglobin (HbA1c) (≤6.5% [48 mmol/mol] and ≤7% [53 mmol/mol]) were assessed using mixed-effects fractional logistic and linear regression models. Sex, age (categorized), diabetes duration (categorized), body mass index standard deviation score (categorized), and treatment modality were included as covariates.

Data of 7691 individuals (mean [standard deviation] age of 13.7 [4.3] years, diabetes duration 6.3 [4.2] years, 47.8% female) were included. AID users were the most likely to achieve TITR target (adjusted mean [standard error of the mean] 41.2% [2.9]), followed by CGM with insulin pump (25.2% [2.3]) and CGM with injections (13.7% [1.5], P < 0.001). A similar association was observed for proportions of individuals achieving TIR and HbA1c targets (P < 0.001). Age <6 years was associated with a higher coefficient of variation (CV) (P < 0.001) and a lower probability of achieving both TITR and TIR targets compared with other age groups (P < 0.001). In analyses of TITR associated with mean sensor glucose stratified by CV, a higher TITR for a lower CV was observed only at mean glucose levels below 150-160 mg/dL; above this threshold, the pattern reversed, with lower CV associated with lower TITR at a given mean glucose level.

Children younger than 6 years and individuals not using glucose-responsive insulin therapy were less likely to meet the recommended glycemic targets. It is imperative to minimize these disadvantages.