Sensor-augmented pump therapy from the diagnosis of childhood type 1 diabetes: results of the Paediatric Onset Study (ONSET) after 12 months of treatment

Abstract

Aims/hypothesis The value of managing children with type 1 diabetes using a combination of insulin pump and continuous glucose monitoring starting from diagnosis for improving subsequent glycaemic control and preserving residual beta cell function was determined. Methods A total of 160 children (aged 1-16 years, mean± SD: 8.7±4.4 years; 47.5% girls) were randomised to receive insulin pump treatment with continuous glucose monitoring or conventional self-monitoring blood glucose measurements. The primary outcome was the level of HbA 1c after 12 months. Other analyses included fasting C-peptide, glycaemic variability, sensor usage, adverse events, children's health-related quality of life and parent's wellbeing. Results HbA 1c was not significantly different between the two groups, but patients with regular sensor use had lower values (mean 7.1%, 95% CI 6.8-7.4%) compared with the combined group with no or low sensor usage (mean 7.6%, 95% CI 7.3-7.9%; p=0.032). At 12 months, glycaemic variability was lower in the sensor group (mean amplitude of glycaemic excursions 80.2 ± 26.2 vs 92.0 ± 33.7; p=0.037). Higher C-peptide concentrations were seen in sensor-treated 12-to 16-year-old patients (0.25±0.12 nmol/l) Electronic supplementary material The online version of this article

Salient Characteristics of Youth with Type 1 Diabetes Initiating Continuous Glucose Monitoring

“…24 The value of managing youth with type 1 diabetes from diagnosis using a combination of CSII and CGM, in comparison with CSII and blood glucose monitoring, was previously evaluated, and no differences were found between the two groups in 1 year with respect to HbA1c. 25 More studies, however, are needed to better understand the impact of multiple diabetes technologies on diabetes care. In fact, there is an ongoing study aimed at comparing durability of CGM use when implemented at the time of initiating CSII compared with a delay of 6 months for the CGM start.…”

Real-time continuous glucose monitoring (CGM) integrated into the treatment of type 1 diabetes: Consensus of experts from SFD, EVADIAC and SFE

“…Glucose variability is rarely studied and the criteria of measurement differ. The Onset Trial paediatric study shows a reduction in MAGE with the sensor-augmented pump vs the pump and SMBG [47].…”

“…Satisfaction with treatment is high among parents and children with type 1 diabetes, whether the control of diabetes is improved [51] or not (evidencing the importance of low glucose alarms in particular in young children) [48]. The Onset Trial study shows, with validated QoL scales, an improvement in well-being and QoL in children and a decrease in parental depression in the year following the diagnosis, in comparison with the group receiving the same treatment with pumps without sensors [47]. Finally, it is interesting to note that the group of children treated with sensors in the Switch study shows a significant reduction in absences from school [50].…”

“…Seven of the studies focus on adults and children/ adolescents and four focus only on a paediatric population [24,31,47,48]. The international recommendations on the use of CGM with children and adolescents have just been published [49].…”

“…The technical nature of each of these devices requires, for the majority of patients and their families, a separate period of learning and adaptation, in the current state of the technologies. Nevertheless, in paediatric situations, recent data suggest that use of CGM with a pump from the time the diabetes is diagnosed can be helpful in the prevention of severe hypoglycaemias [47].…”