In Youths With T1D, Real-time CGM Plus Insulin Pump Use Linked to Better Time-in-Range Achievement

Youths with type 1 diabetes (T1D) concurrently using a real-time continuous glucose monitoring (CGM) device and insulin pump had a significantly higher time in range, were more likely to achieve recommended clinical targets, and had a lower probability of severe adverse events compared with youths using other treatment modalities.

These findings were published in JAMA Network Open.

“These results underscore the synergistic effect of advanced diabetes technologies that should be more readily available to youths with [T1D] for further improvement of diabetes-related clinical outcomes,” the authors wrote.

The multinational cohort study included 5219 individuals younger than 21 years. The group was 52% male, with a median (IQR) age of 14.4 (11.2-17.1) years, T1D duration of 5.2 (2.7-8.7) years, and hemoglobin A_1c (HbA_1c) level of 7.4% (6.8%-8.0%).

These participants were enrolled from the international Better Control in Pediatric and Adolescent Diabetes: Working to Create Centers of Reference (SWEET) registry, with CGM data available between January 2016 and December 2021 across 21 countries.

Participants were unevenly divided into 4 treatment modalities:

• intermittently scanned CGM with insulin pump (16.3%)
• intermittently scanned CGM with injection (23.6%)
• real-time CGM with insulin pump (43.2%)
• real-time CGM with injection (17.0%)

The authors found that treatment modality was associated with the proportion of youths achieving recommended clinical targets. Results were adjusted for sex, age, T1D duration, and body mass index standard deviation score.

With a recommended time-in-range (70-180 mg/dL) target of more than 70%, the proportion of youths achieving this target was highest among those using real-time CGM plus an insulin pump (36.2%; 95% CI, 33.9%-38.4%). This proportion was second highest among those using real-time CGM with injection (20.9%; 95% CI, 18.0%-24.1%), followed by intermittently scanned CGM plus injection use (12.5%; 95% CI, 10.7%-14.4%), then intermittently scanned CGM plus insulin pump use (11.3%; 95% CI, 9.2%-13.8%) (P < .001).

It should be noted that the group with the highest proportion of youths achieving the time-in-range target also had the highest number of participants assigned to that group.

Similar trends were observed for less than 25% time above range and less than 4% time below range targets.

The adjusted time in range was highest among participants using real-time CGM plus an insulin pump at 64.7% (95% CI, 62.6%-66.7%), with an unadjusted time in range for this group of 65.4% (IQR, 54.5%-74.1%). The authors called this an encouraging finding as it approached the consensus guideline target of 70% for youths with T1D.

A previous SWEET study showed an association between CGM use and both lower HbA_1c levels and fewer episodes of diabetic ketoacidosis requiring hospitalization, compared with participants not using CGM. The current study supported these findings, demonstrating that treatment modality was linked to the proportion of youths with T1D experiencing certain severe adverse events.

The use of real-time CGM with or without an insulin pump was associated with a lower proportion of youths experiencing severe hypoglycemic events compared with the use of intermittently scanned CGM with or without an insulin pump.

Similarly, the proportion of youth experiencing at least 1 diabetic ketoacidosis event was higher in the groups using intermittently scanned CGM compared with the groups using real-time CGM.

Reference

Dovc K, Lanzinger S, Cardona-Hernandez R, et al. Association of achieving time in range clinical targets with treatment modality among youths with type 1 diabetes. JAMA Netw Open. 2023;6(2):e230077. doi:10.1001/jamanetworkopen.2023.0077