Automated insulin delivery in war refugee children with type 1 diabetes: a 3-year follow-up

Following the war in Ukraine, Europe received a large influx of war refugees, including children with type 1 diabetes (CwD). The aim of this study was to describe their diabetes control during the first three years.

A total of 143 (70 M, 73 F) CwD were recruited into this longitudinal observational study between March 2022 and June 2025 at 9 tertiary pediatric diabetes centers. The following data were collected yearly: treatment type, CGM use, anthropometrics, HbA1c, and CGM metrics. Statistical inference was performed using linear mixed models adjusting for age, sex, age at T1D onset, and therapy type. Additionally, the participants were compared to matched controls from a nationwide pediatric diabetes registry.

The median HbA1c decreased significantly from 58.0 mmol/mol, 7.5% (IQR 49.0-73.0, 6.6-8.8%) to 52 mmol/mol, 6.9% (IQR 48-64 mmol/mol, 6.5-8.0%) over 3 years (P<0.001). We observed a significant increase in CGM use (46.4% to 95.5%) and insulin pump use, from 8.0% (no AID systems) to 63.6% (only AID systems) (both P<0.001). The trend in HbA1c decline depended on the therapy type, the estimated effect of AID initiation was -5.39 mmol/mol (95% CI -10.12 to -0.65 mmol/mol) (P = 0.003). The mean time in range (TIR) of CwD who initiated AID was not significantly different from that of matched non-migrant controls (73.4% vs. 71.0%, P = 0.420), while those using insulin pens had a lower TIR than controls (51.8% vs. 62.9%, P = 0.003).

We observed a significant improvement in T1D control among refugee CwD, emphasizing the role of AID, regardless of socioeconomic background.