Insulin pump therapy in children with type 1 diabetes: analysis of data from the SWEET registry

Abstract

Background Intensified insulin delivery using multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII) is recommended in children with type 1 diabetes (T1D) to achieve good metabolic control. Objective To examine the frequency of pump usage in T1D children treated in SWEET (Better control in Paediatric and Adolescent diabeteS: Working to crEate CEnTers of Reference) centers and to compare metabolic control between patients treated with CSII vs MDI. Methods This study included 16 570 T1D children participating in the SWEET prospective, multicenter, standardized diabetes patient registry. Datasets were aggregated over the most recent year of treatment for each patient. Data were collected until March 2016. To assess the organization of pump therapy a survey was carried out. Results Overall, 44.4% of T1D children were treated with CSII. The proportion of patients with pump usage varied between centers and decreased with increasing age compared with children treated with MDI. In a logistic regression analysis adjusting for age, gender and diabetes duration, the use of pump was associated with both: center size [odd ratio 1.51 (1.47‐1.55), P < .0001) and the diabetes‐related expenditure per capita [odd ratio 1.55 (1.49‐1.61), P < .0001]. Linear regression analysis, adjusted for age, gender, and diabetes duration showed that both HbA1c and daily insulin dose (U/kg/d) remained decreased in children treated with CSII compared to MDI (P < .0001). Conclusions Insulin pump therapy is offered by most Sweet centers. The differences between centers affect the frequency of use of modern technology. Despite the heterogeneity of centers, T1D children achieve relatively good metabolic control, especially those treated with insulin pumps and those of younger age.

Weight‐based carbohydrate treatment of hypoglycaemia in people with Type 1 diabetes using insulin pump therapy: a randomized crossover clinical trial

“…The use of CSII is increasingly common in the modern management of children and adults with Type 1 diabetes, allowing them to manage their diabetes intensively and optimize glycaemic control . While CSII offers advantages over traditional insulin delivery systems by providing greater flexibility in the timing of meals and snacks, it still does not protect the patient from hypoglycaemia.…”

ISPAD Clinical Practice Consensus Guidelines 2018: Diabetes technologies

“…Data from the US‐based type 1 diabetes exchange (T1DX) registry focusing on children <6 years demonstrated lower HbA1c levels for those on pumps, with a tendency for lower HbA1c levels prior to pump initiation, suggesting selection of an ideal population for pump use may have occurred . The SWEET (better control in Pediatric and Adolescent Diabete S: W orking to create C E n T ers of Reference) centers found that almost half of the 16 000 registry participants used pumps, and this technology was associated with lower HbA1c and daily insulin dose as compared to MDI . In a cross‐sectional comparison of three large, transatlantic registries, which included the US‐based T1DX, the German/Austrian Prospective Diabetes Follow‐up Registry (DPV), and the English/Welsh National Pediatric Diabetes Audit (NPDA), a pooled analysis of nearly 55 000 pediatric participants, pump use was associated with lower mean HbA1c (pump 8.0% ± 1.2% vs injection: 8.5% ± 1.7%, P < 0.001) .…”

Real‐world outcomes of insulin pump compared to injection therapy in a population‐based sample of children with type 1 diabetes

“…Over the last decade, the use of insulin pump therapy in the pediatric age group has markedly increased . In two recently published cross‐sectional studies that explored data from two large registries, insulin pump therapy was reported to be superior for glycemic control compared to multiple daily injections (MDI) . However, there is limited data on the long‐term outcomes (glycemic outcomes as well as acute complications) of insulin pump therapy in a real‐world population‐based setting.…”