Abstract Body

Advanced technologies have become an integral part of type 1 diabetes (T1D) management.

The aim of this presentation is to review current technologies with emphasis on the advantages and disadvantages of their use from the onset of T1D.

Immediate start of pump therapy at the time of diagnosis has been shown to be successful in terms of glycemic control achieved and might help to preserve residual β-cell function, although larger clinical trials would be required to confirm this. In very young children, the advantages are more evident and related to the need for a more physiological delivery of precise doses of insulin through continuous subcutaneous insulin infusion (CSII) rather than multiple daily injections (MDI). Furthermore, parents of children treated with CSII reported superior quality of life for their children compared with parents of children treated to MDI but CSII use is lower in patients from ethnic minorities and those with the greatest socio-economic deprivation.

Initiation of technological devices so early in the course of T1D requires highly coordinated teamwork to provide the education needed for youth and families to manage a large volume of data and notions to learn. The use of CSII may be associated with an increased risk of diabetes ketoacidosis (DKA) due to unrecognized malfunction and/or failure of the device. Other potential complications are infusion site infections and lipodystrophies.

In our experience, intensive MDI/CSII regimens from the onset of diabetes are both safe and efficient. Data from the SCIPI (subcutaneous insulin: pumps or injections?) study on TID children and young people newly diagnosed, indicate that the use of CSII was neither clinically beneficial nor cost-effective in the first year of type 1 diabetes, concluding that resources could be more effectively invested in other measures to improve glycemic control.

Recent studies show instead the importance of closed-loop in the pediatric T1D population, even at the onset. In particular, the ongoing CLOuD study (a randomised parallel study protocol) was aimed at assessing the effect of closed-loop insulin delivery from the onset of type 1 diabetes in youth on residual beta-cell function compared to standard insulin therapy. The future widespread use of an advanced hybrid closed-loop from the onset of diabetes will improve and probably change the metabolic outcomes.