Background To assess change in rates of pediatric real time or intermittent scanning CGM use over the past 5 years, and how it impacts glycemic control, data from 2 registries were compared: the US-based T1DX and the German/Austrian DPV. Methods Registry participants aged <18 years with T1D duration ≥ 1 year encompassed 29,007 individuals in 2011 and 29,150 participants in 2016. Demographic data, CGM use and HbA1c were obtained from medical records. Results CGM use increased from 2011 to 2016 in both registries across all age groups, regardless of gender, ethnic minority status or insulin delivery method. The increase in CGM use was most pronounced in the youngest patients, and usage rates remain lowest for adolescent patients in 2016. For both registries in 2016, mean HbA1c was lower among CGM users regardless of insulin delivery method compared to pump only (P<0.001) and injection only (P<0.001), and CGM users were more likely to achieve glycemic target of HbA1c <7.5% (56% vs. 43% for DPV and 30% vs. 15% for T1DX, P<0.001). T1DX participants had a higher mean HbA1c compared with DPV despite whether they were CGM users or non-users; however, the difference was less pronounced in CGM users (P<0.001). Conclusions/interpretation Pediatric CGM use increased in both registries and was associated with lower mean HbA1c regardless of insulin delivery modality.

To investigate temporal trends and contemporary use of insulin pump therapy and glucose monitoring in type 1 diabetes. RESEARCH DESIGN AND METHODS In a population-based study, we analyzed the use of insulin pump therapy, continuous glucose monitoring (CGM), and self-monitoring of blood glucose (SMBG) from 1995 to 2017 in patients with type 1 diabetes identified from the Diabetes Prospective Follow-up (DPV) database in Germany and Austria. Patients were stratified by age, sex, migration background, and country. RESULTS Among 96,547 patients with type 1 diabetes (median age 17.9 years, 53% males), the percentage using insulin pump therapy increased from 1% in 1995 to 53% in 2017, with the highest rates in the youngest patients (92% in preschoolers, 74% in children, 56% in adolescents aged <15 years, 46% in adolescents aged ‡15 years, 37% in adults). The percentage of patients using CGM increased from 3% in 2006 to 38% in 2017, with the highest rates in the youngest patients (58%, 52%, 45%, 33%, and 15% of respective age-groups). Daily SMBG frequencies increased from 1995 to 2016 and decreased afterward, most prominently in the youngest patients. Between 2015 and 2017, pump therapy was more frequently used in female versus male adolescents and adults (all P < 0.001), while no sex differences were observed for pump use in children <10 years (all P 5 1.0) and for CGM use in all age-groups (all P 5 1.0). CONCLUSIONS Since 1995, insulin pump use has continuously increased, and insulin pump therapy is now standard in patients aged <15 years. CGM use sharply rose in recent years, particularly in young children.

Objective Continuous subcutaneous insulin infusion (CSII) is on the rise among pediatric patients with type 1 diabetes mellitus. Metabolic effects alone cannot explain this rising popularity. From the patient's perspective, the main benefits of CSII may be found in subjective psychosocial health outcomes (patient‐reported outcomes [PRO]). Subjects and Methods In a multicenter open randomized controlled trial, children and adolescents aged 6 to16 years currently treated with multiple daily injections (MDI) were randomized 1:1, stratified by center, to either starting with CSII immediately after the baseline interview or to continuing MDI while waiting 6 months for transmission to CSII. The primary outcomes were patient‐reported diabetes‐specific health‐related quality of life (DHRQOL) and diabetes burden of the main caregiver. Secondary outcomes were caregiver stress, fear of hypoglycemia, satisfaction with treatment, and HbA1c. Results Two‐hundred and eleven patients were randomized between February 2011 and October 2014, and 186 caregivers and 170 patients were analyzed using the intention‐to‐treat principle for primary outcomes. Children 8 to 11 years in the CSII group reported improved DHRQOL at follow‐up compared to MDI (median difference [MD] 9.5, 95% confidence interval [CI] 3.6‐16.7, P = 0.004). There were no treatment differences in the adolescent age‐group 12 to 16 years (MD 2.7; 95% CI −3.2‐9.5; P = 0.353). The main caregivers of the CSII group reported a significant decline of overall diabetes burden at follow‐up compared to the MDI group (MD 0; 95% CI −1‐0; P = 0.029). Secondary PROs also were in favor of CSII. Conclusions CSII has substantial psychosocial benefits. PROs demonstrate these benefits. Registered as NCT01338922 at http://clinicaltrials.gov

The discontinuation rate of insulin pump therapy is, in general, low (4%). The younger the patients at the time of initiating insulin pump treatment, the lower is the discontinuation rate. The highest rate was seen in adolescents aged 10-15 yr. Girls stopped insulin pump treatment more often than boys (60.5% vs. 39.5%).

No abstract

OBJECTIVEThe prevalence of cystic fibrosis–related diabetes (CFRD) has increased with improved life expectancy of patients. Clinical and care characteristics were compared with type 1 diabetes mellitus (T1DM) in a multicenter analysis of pediatric data.RESEARCH DESIGN AND METHODSAuxological and treatment data from 47,227 patients aged younger than 21 years with CFRD or T1DM in the German/Austrian Diabetes Prospective Documentation Initiative registry were analyzed by multivariable mixed regression modeling.RESULTSDiabetes onset (mean [interquartile range]) occurred later in individuals with CFRD (14.5 [11.8–16.3] years) than in individuals with T1DM (8.5 [4.9–11.8] years), with female preponderance in CFRD (59.1% vs. 47.5%; P < 0.01). CFRD patients had lower BMI standard deviation scores (−0.85 [−1.59 to −0.12] vs. +0.52 [−0.10 to +1.16]; P < 0.01) and lower HbA1c (6.87% vs. 7.97%; P < 0.01). Self-monitoring of blood glucose was more frequent in patients with T1DM (4.5 vs. 3.5; P < 0.01); 72% of CFRD patients received insulin. In insulin-treated patients, insulin dosage adjusted for age, sex, and diabetes duration differed significantly (T1DM: 0.79 IE per kilogram of body weight; CFRD: 0.83 IE per kilogram of body weight). Use of short-acting and long-acting insulin analogs was significantly more frequent in T1DM (47% vs. 39% and 37% vs. 28%; both P < 0.05). Metabolic control in CFRD patients without insulin was better compared with CFRD on insulin (HbA1c: 6.00 vs. 7.12; P < 0.01), but duration of disease was significantly shorter (0.8 years [0.1–2.4] compared with 2.4 years [0.6–4.6]). There was no significant difference for BMI standard deviations scores between CFRD patients with or without insulin treatment.CONCLUSIONSPediatric patients with CFRD show clear auxological and metabolic differences from those with T1DM, with different treatment choices.

Our data indicate a strong correlation between hyperglycaemia and the development of necrobiosis lipoidica. We postulate that the underlying pathogenic processes differ from those leading to microalbuminuria and retinopathy, and additional immunological mechanisms may play a role.

Implementation of the LISA method on a neonatal ward was safe and feasible and was associated with less need for mechanical ventilation in infants >24 weeks. As our study was retrospective the observed trends for better pulmonary and neurocognitive outcomes should be interpreted with caution until results from randomized trials on the LISA procedure are available.