Does Current Diabetes Technology Improve Metabolic Control? A Cross-Sectional Study on the Use of Insulin Pumps and Continuous Glucose Monitoring Devices in a Nationwide Pediatric Population

Heiko Bratke, Hanna D Margeirsdottir, Jörg Assmus, Pål R Njølstad, Torild Skrivarhaug, Heiko Bratke, Hanna D Margeirsdottir, Jörg Assmus, Pål R Njølstad, Torild Skrivarhaug

Abstract

Objective: To examine the use of multiple daily injections (MDI), insulin pumps, self-measured blood glucose (SMBG), and continuous glucose monitoring (CGM) systems, and their association with glycated hemoglobin (HbA1c), diabetic ketoacidosis (DKA), and severe hypoglycemia.

Methods: In a pediatric population-based nationwide cross-sectional study, we analyzed data from 2623 participants up to 18 years of age with type 1 diabetes, using 2017 annual data from the Norwegian Childhood Diabetes Registry. HbA1c was adjusted for age, gender, and diabetes duration. Using a linear mixed-effects model, we assessed HbA1c and the incidence of DKA and severe hypoglycemia according to the use of MDI, insulin pumps, SMBG, and CGM.

Results: We observed that 74.7% of participants were using an insulin pump and 52.6% were using a CGM system. Mean HbA1c was 7.8% (62 mmol/mol). The HbA1c of pump users was 0.14 percentage points (pp) higher than that of MDI users. Fewer pump users than MDI users achieved an HbA1c of < 7.5% (38.3 vs. 41.6%). CGM users had a 0.18 pp lower HbA1c than SMBG users, with 40.5 and 38.0%, respectively, achieving an HbA1c of < 7.5%. The incidence of severe hypoglycemia or hospitalization due to DKA was not different in pump and CGM users compared with nonusers. Compared with other insulin pumps, patch pump use was associated with a significantly lower odds ratio for DKA.

Conclusions: Despite the broad use of diabetes technology, as many as 61% of our pediatric cohort did not reach the HbA1c target recommended by the International Society for Pediatric and Adolescent Diabetes (ISPAD). Lower HbA1c was associated with CGM use but not with insulin pump use. Acute complications were not less frequent in the groups using insulin pumps or CGM compared with those using MDI and SMBG. Further research is required to explore the lower incidence of DKA among patch pump users.

Trial registration: ClinicalTrials.gov identifier NCT04201171.

Keywords: Continuous glucose monitoring; Continuous subcutaneous insulin infusion; Diabetes Mellitus; Diabetic ketoacidosis; Glycosylated hemoglobin; Hypoglycemia/prevention and control; Type 1.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Outcome measures included HbA1c (adjusted for age, gender, and diabetes duration), incidence of diabetic ketoacidosis, and hospitalization for severe hypoglycemia in the different user groups of the insulin delivery (CSII, MDI) and glucose monitoring (CGM yes/no) systems (a) and according to the specific CSII and CGM models (b). HbA1c groups, incidence of diabetic ketoacidosis and severe hypoglycemia: Bars represent the number of individuals, and the percentage of the total cohort is given on the x-axis. CSII Continuous subcutaneous insulin infusion, CGM continuous glucose monitoring, HbA1c glycated hemoglobin, MDI multiple daily injections
Fig. 2
Fig. 2
Estimated marginal means plot with predicted adjusted HbA1c for CSII and CGM and the different models in use. CI Confidence interval

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Source: PubMed

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