Abstract
Background Technology in Diabetes has been rapidly evolving in order to help optimize blood glucose(BG) control in diabetic patients.
Objectives Analysis of glycemic control(GC) in children and young people with Type 1 Diabetes Mellitus(CYP T1D) using Insulin Pump(IP) compared to those on Multiple Daily Injection(MDI) insulin regimen and assess if modality of BG monitoring has an impact on GC. To further assess the correlation of GC with age of the patient. Secondary outcomes included severe hypoglycemia and DKA episodes.
Methods Retrospective data was collected from FilePromaker database from June 2019 to October 2020 for all CYP T1D under the care of the Paediatric Diabetic Unit.This included data on age,management regime,modality of BG monitoring,HbA1c (laboratory and validated point of care blood tests at each diabetes related appointment), Diabetic Ketoacidosis (DKA) readmissions and severe hypoglycemia episodes. Mean HbA1c(mHb) was calculated for each patient during the study period in mmol/mol. GC was compared in two groups IP and MDI. Further analysis to evaluate impact of modality used for BG monitoring was undertaken. This included finger prick self blood glucose monitoring (SBGM) with a smart BG meter, flash glucose monitoring (FGM) or continuous glucose monitor (CGM). We also further looked at GC for children under 12 years(y) and over 12y in each group.
Results
Total CYP T1D included in study were 241.
MDI users were 143(60%) and IP users were 98(40%).
Mean HbA1C in mmol/mol in IP group was 61.9(SD 10.23) & MDI group was 71.1(SD 17.34) which was statistically significant (t value of-4.74 and significance p<0.00).
GC overall in <12y vs >12y with mHb 60.98 vs 69.09( t= -58.91,p<0.00).
In MDI group: mHb was highest in patients on FGM >12y=78.4; & lowest in those on SBGM <12y=61.5.
However in Patients on IP: those on CGM and <12y had the lowest mHb of 56.1 and highest in those using FGM >12y=66.
Readmissions with DKA episodes were 3, all above 12y of age, MDI(2) vs IP(1).
Admissions with severe hypoglycemia were 8,75% on MDI and 25% on IP.
Based on modality of BG monitoring: best GC noted in group IP using CGM vs SBGM in group MDI. GC was worst in those using FGM in both groups.
Conclusions
IP usage led to statistically significant improved glycemic outcomes irrespective of age.
CGM usage results in improved GC irrespective of whether using IP or MDI.
FGM was beneficial in only those younger than 12y & offered no advantage in improvement of GC over SBGM in >12y irrespective of modality of Insulin delivery.
Overall GC was best in <12y irrespective of Insulin Delivery Modality
Complications of DKA and severe hypoglycemia episodes were more pronounced in those on MDI.
