As the access to diabetes technology has improved, the spectrum of treatment modalities for T1DM has diversified. We aim to examine different treatment modalities in a large, international diverse cohort of children and adolescents from the SWEET-Registry.
Subjects with ≥ 1year T1DM duration, aged ≤18 years and documented pump/sensor usage during the period August 2017-July 2019 were selected and stratified in four categories: Injections; Injections+Sensor; Pump; Pump+Sensor. HbA1c and proportion of patients with DKA or severe hypoglycemia (SH) were analyzed. Linear/logistic regression models adjusted for demographics, region and Gross-Domestic-Product (GDP)-per capita were applied.
25,654 Subjects, (median age 13.80 [Q1;Q3: 10.60; 16.40, 95%CI] years; males 51.41 %; diabetes duration 5.18[2.99;8.25] years) were included in the analysis.
| Injections No sensor | Injections +Sensor | Pump No sensor | Pump +Sensor | |
| N (%) | 9606 (37.5) | 3843 (15.0) | 4418 (17.2) | 7787 (30.3) |
| Subjects with HbA1c <58 mmol/mol (%) | 26.32 | 39.68** | 45.78** | 44.11** |
| Subjects with HbA1c <53 mmol/mol (%) | 14.58 | 24.08** | 27.89** | 26.47** |
| HbA1c (mmol/mol)§ | 71.9 (71.5-72.3) | 67.1 (66.5-67.6)** | 64.8 (64.3-65.3)** | 61.7 (61.3-62.1)** |
| DKA (%)§ | 2.92 (2.58-3.35) | 2.84 (2.36-3.42) | 2.03 (1.65-2.50)* | 1.99 (1.70-2.32)** |
| SH (%)§ | 2.22 (1.92-2.56) | 4.06 (3.48-4.73)** | 1.11 (0.86-1.45)** | 2.24 (1.93-2.60) |
§Adjusted for demographics, region, and GDP; * p-value <0.05; **p-value <0.01
Lower HbA1c and DKA were observed in subjects using technology (pump +/- sensor). Pump use was associated with lower rate of SH, while sensor use was associated with more SH. Residual confounding,preferential use of sensors in patients at risk or increased awareness of SH may explain these findings.