Background and Aims

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.

Methods

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.

Results

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.

^§Adjusted for demographics, region, and GDP; * p-value <0.05; **p-value <0.01

Conclusions

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.

Background and Aims / Part 1

Access to technology is nowadays essential to provide a state-of-the-art care of type 1 diabetes. Different studies have provided evidence that the use of pump and sensors is effective and safe to accomplish glycemic control goals; however, access to technology depends on the reimbursement policies which are very variable among the different countries in the European Union.

Methods / Part 2

For pumps, several studies have shown a gradient north-south in the use of insulin pumps, strongly correlated to reimbursement and % GDP investment in health. For sensors, there are inequalities in the type and grade of reimbursement within different countries across the European Union and sometimes in different areas of the same country. Although, there is clear evidence that socioeconomic factors are very closely linked with the accomplishment of glycemic goals, data regarding performance of diabetes in minorities are really lacking in European populations. In addition, the cultural and linguistical diversity of Europe, makes difficult to establish an accurate and broadly accepted definition of the term minority, which varies among the different countries.

Results / Part 3

Although it may seem that equity in the access to diabetes technology in Europe is guaranteed no matter if the individual belongs or not to an ethnic minority, the truth is that accessibility to diabetes education is inextricably linked with the ability to speak the native language of a certain country and the adoption of the country native culture. Regarding pediatric care, many young children belonging to ethnic minorities are able to speak fluidly the official languages of the country where they live, but their relatives are not always in the same situation and disbalances in the access to information and education compromises the capacity to choose and learn how to use the technology.

Conclusions / Part 4

The refugee movement that Europe has been witnessing during the last few years is testing the ability of Europe to provide equality and equity access to technological diabetes therapies.