Background and Aims

The utilization of CSII in type 1 diabetes (T1D) is associated with increased risk of diabetic ketoacidosis (DKA). The rationale behind using hybrid modality, long-acting insulin for basal coverage and CSII for boluses, is the prevention of insulin delivery failure and subsequent hyperglycemia and DKA.

To explore the hybrid treatment modality in clinical practice in youth with T1D.

Methods

Multicenter, observational study of youth with T1D who initiated hybrid modality between 2013 and 2020. Extracted from the medical records were data on sociodemographic characteristics, reason for hybrid treatment initiation, glycemic metrics, HbA1c and frequency of DKA episodes, collected at initiation, after 6 months, and at last visit.

Results

Fifty-five patients (52.7% males) were treated with hybrid therapy, median [IQR] age at initiation 14.5years [12.4, 17.3], HbA1c 9.2% [8.2, 10.2], mean glucose levels 221mg/dL [181, 226] and treatment duration 18 months [12, 47]. Hybrid treatment was initiated due to fear of sustained hyperglycemia in 41.8%, DKA episodes in 30.8%, refusal to use CSII continuously in 14.6%. HbA1c did not significantly change throughout follow-up (P=0.262 and P=0.195). Mean glucose levels decreased after 6 months (P=0.034), and remained stable thereafter (P=0.274). Frequency of DKA decreased after 6 months and at last visit as compared with 6 months preceding initiation of hybrid therapy (number of events/number of patients: 4/4 and 10/10 vs. 24/14, P=0.002 and P=0.031, respectively).

Conclusions

Our findings suggest that this hybrid therapy is a feasible option in the management of youth with T1D, which may reduce the risk of DKA episodes.