Glycemic Outcome Associated With Insulin Pump and Glucose Sensor Use in Children and Adolescents With Type 1 Diabetes. Data From the International Pediatric Registry SWEET

OBJECTIVE This study aims to examine insulin delivery methods, glucose monitoring modalities and related outcomes in a large, international, diverse cohort of children and adolescents with type 1 diabetes from the SWEET-Registry RESEARCH DESIGN AND METHODS Participants with type 1 diabetes of >1 year of duration, aged ≤18y and documented pump/sensor usage during the period August 2017-July 2019 were stratified into four categories: injections-no sensor (reference); injections+sensor; pump-no sensor; pump+sensor. HbA1c and proportion of patients with DKA or SH were analyzed; linear and logistic regression models adjusted for demographics, region and gross-domestic-product (GDP)-per capita were applied. RESULTS Data of 25,654 subjects were analyzed. Injections-no sensor: 37.44% [adjusted-HbA1c 8.72 (95%CI 8.68-8.75)]; injections+sensor: 14.98% [adjusted-HbA1c 8.30 (8.25-8.35)]; pump-no sensor: 17.22% [adjusted-HbA1c 8.07 (8.03-8.12)]; pump+sensor: 30.35% [adjusted-HbA1c 7.81 (7.77-7.84)]. HbA1c was lower in all categories of subjects using pump and/or sensor compared to injections-no sensor treatment method (p<0.001, respectively). Proportion of DKA episodes was lower in subjects with pump+sensor [1.98 (1.64-2.48); p<0.001] and pump-no sensor [2.02 (1.64-2.48); p<0.05)] when compared to injections-no sensor [2.91 (2.59-3.31)]. Proportion of SH was lower in pump-no sensor [1.10 (0.85-1.43); p<0.001] but higher in the injections+sensor [4.25 (3.65-4.95); p<0.001] compared to injections-no sensor [2.35 (2.04-2.71)]. CONCLUSIONS Lower HbA1c and fewer DKA episodes were observed in subjects using either a pump, CGM or both. Pump use was associated with lower rate of SH. Across SWEET centers, use of pumps and CGM is increasing. The concomitant use of pump and CGM was found to be associated with an additive benefit.

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Glycemic Outcome Associated With Insulin Pump and Glucose Sensor Use in Children and Adolescents With Type 1 Diabetes. Data From the International Pediatric Registry SWEET

10.2337/figshare.13746730.v1 ◽

2021 ◽

Author(s):

Roque Cardona-Hernandez ◽

Anke Schwandt ◽

Hessa Alkandari ◽

Heiko Bratke ◽

Agata Chobot ◽

...

Keyword(s):

Type 1 Diabetes ◽

Children And Adolescents ◽

Glucose Sensor ◽

Insulin Pump ◽

Glucose Monitoring ◽

Treatment Method ◽

Logistic Regression Models ◽

Design And Methods ◽

No Sensor

OBJECTIVE This study aims to examine insulin delivery methods, glucose monitoring modalities and related outcomes in a large, international, diverse cohort of children and adolescents with type 1 diabetes from the SWEET-Registry RESEARCH DESIGN AND METHODS Participants with type 1 diabetes of >1 year of duration, aged ≤18y and documented pump/sensor usage during the period August 2017-July 2019 were stratified into four categories: injections-no sensor (reference); injections+sensor; pump-no sensor; pump+sensor. HbA1c and proportion of patients with DKA or SH were analyzed; linear and logistic regression models adjusted for demographics, region and gross-domestic-product (GDP)-per capita were applied. RESULTS Data of 25,654 subjects were analyzed. Injections-no sensor: 37.44% [adjusted-HbA1c 8.72 (95%CI 8.68-8.75)]; injections+sensor: 14.98% [adjusted-HbA1c 8.30 (8.25-8.35)]; pump-no sensor: 17.22% [adjusted-HbA1c 8.07 (8.03-8.12)]; pump+sensor: 30.35% [adjusted-HbA1c 7.81 (7.77-7.84)]. HbA1c was lower in all categories of subjects using pump and/or sensor compared to injections-no sensor treatment method (p<0.001, respectively). Proportion of DKA episodes was lower in subjects with pump+sensor [1.98 (1.64-2.48); p<0.001] and pump-no sensor [2.02 (1.64-2.48); p<0.05)] when compared to injections-no sensor [2.91 (2.59-3.31)]. Proportion of SH was lower in pump-no sensor [1.10 (0.85-1.43); p<0.001] but higher in the injections+sensor [4.25 (3.65-4.95); p<0.001] compared to injections-no sensor [2.35 (2.04-2.71)]. CONCLUSIONS Lower HbA1c and fewer DKA episodes were observed in subjects using either a pump, CGM or both. Pump use was associated with lower rate of SH. Across SWEET centers, use of pumps and CGM is increasing. The concomitant use of pump and CGM was found to be associated with an additive benefit.

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Glycemic Outcome Associated With Insulin Pump and Glucose Sensor Use in Children and Adolescents With Type 1 Diabetes. Data From the International Pediatric Registry SWEET

10.2337/figshare.13746730 ◽

2021 ◽

Author(s):

Roque Cardona-Hernandez ◽

Anke Schwandt ◽

Hessa Alkandari ◽

Heiko Bratke ◽

Agata Chobot ◽

...

Keyword(s):

Type 1 Diabetes ◽

Children And Adolescents ◽

Glucose Sensor ◽

Insulin Pump ◽

Glucose Monitoring ◽

Treatment Method ◽

Logistic Regression Models ◽

Design And Methods ◽

No Sensor

OBJECTIVE This study aims to examine insulin delivery methods, glucose monitoring modalities and related outcomes in a large, international, diverse cohort of children and adolescents with type 1 diabetes from the SWEET-Registry RESEARCH DESIGN AND METHODS Participants with type 1 diabetes of >1 year of duration, aged ≤18y and documented pump/sensor usage during the period August 2017-July 2019 were stratified into four categories: injections-no sensor (reference); injections+sensor; pump-no sensor; pump+sensor. HbA1c and proportion of patients with DKA or SH were analyzed; linear and logistic regression models adjusted for demographics, region and gross-domestic-product (GDP)-per capita were applied. RESULTS Data of 25,654 subjects were analyzed. Injections-no sensor: 37.44% [adjusted-HbA1c 8.72 (95%CI 8.68-8.75)]; injections+sensor: 14.98% [adjusted-HbA1c 8.30 (8.25-8.35)]; pump-no sensor: 17.22% [adjusted-HbA1c 8.07 (8.03-8.12)]; pump+sensor: 30.35% [adjusted-HbA1c 7.81 (7.77-7.84)]. HbA1c was lower in all categories of subjects using pump and/or sensor compared to injections-no sensor treatment method (p<0.001, respectively). Proportion of DKA episodes was lower in subjects with pump+sensor [1.98 (1.64-2.48); p<0.001] and pump-no sensor [2.02 (1.64-2.48); p<0.05)] when compared to injections-no sensor [2.91 (2.59-3.31)]. Proportion of SH was lower in pump-no sensor [1.10 (0.85-1.43); p<0.001] but higher in the injections+sensor [4.25 (3.65-4.95); p<0.001] compared to injections-no sensor [2.35 (2.04-2.71)]. CONCLUSIONS Lower HbA1c and fewer DKA episodes were observed in subjects using either a pump, CGM or both. Pump use was associated with lower rate of SH. Across SWEET centers, use of pumps and CGM is increasing. The concomitant use of pump and CGM was found to be associated with an additive benefit.

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Fasting during the holy month of Ramadan among older children and adolescents with type 1 diabetes in Kuwait

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2019-0009 ◽

2019 ◽

Vol 32 (8) ◽

pp. 843-849 ◽

Cited By ~ 1

Author(s):

Kholoud Mohamed ◽

Dalia Al-Abdulrazzaq ◽

Amel Fayed ◽

Eman El Busairi ◽

Faisal Al Shawaf ◽

...

Keyword(s):

Type 1 Diabetes ◽

Children And Adolescents ◽

Diabetes Management ◽

Insulin Pump ◽

Control Level ◽

Insulin Pump Therapy ◽

Insulin Regimen ◽

Pump Therapy ◽

Significant Difference

Abstract Background To evaluate the safety of fasting during the holy month of Ramadan among children and adolescent with type 1 diabetes (T1D). Methods A retrospective cohort study of 50 children and adolescents with T1D whose mean age was 12.7 ± 2.1 years was conducted. Twenty-seven patients (54%) were on multiple daily injections (MDI) insulin regimen and 23 (46%) were on insulin pump therapy. Before fasting for Ramadan, children and their families were evaluated and educated about diabetes management during Ramadan. Hemoglobin A1c (HbA1c), weight, number of days fasted, hypoglycemia and hyperglycemia episodes, and emergency hospital visits were collected and analyzed after completing the month. Participants were compared according to the insulin treatment regimen and their glycemic control level before Ramadan. Results The children were able to fast 20 ± 9.9 days of Ramadan, and the most common cause for breaking the fast was mild hypoglycemia (7.8% among all cases). There was no significant difference between the two insulin regimen groups in breaking fast days, frequency of hypo- or hyperglycemia, weight and HbA1c changes post Ramadan. Patients with HbA1c ≤ 8.5% were able to fast more days during Ramadan with significantly less-frequent hypoglycemic attacks as compared to patients with HbA1c > 8.5 (1.2 ± 1.5 vs. 3.3 ± 2.9 days of hypoglycemia, p = 0.01, respectively). Conclusions Fasting for children with T1D above the age of 10 years is feasible and safe in both pump and non-pump users, and well-controlled patients are less likely to develop complications. Education of the families and their children before Ramadan, along with intensive monitoring of fasting children during the month are crucial.

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Exercise With and Without an Insulin Pump Among Children and Adolescents With Type 1 Diabetes Mellitus

PEDIATRICS ◽

10.1542/peds.2004-2428 ◽

2005 ◽

Vol 116 (3) ◽

pp. e348-e355 ◽

Cited By ~ 58

Author(s):

G. Admon

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Type 1 Diabetes Mellitus ◽

Children And Adolescents ◽

Insulin Pump

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The Benefits of Insulin Pump Therapy in Children and Adolescents with Type 1 Diabetes

Journal of Pediatric Nursing ◽

10.1016/j.pedn.2014.08.010 ◽

2014 ◽

Vol 29 (6) ◽

pp. 712-713

Author(s):

Stephanie Woerner

Keyword(s):

Type 1 Diabetes ◽

Children And Adolescents ◽

Insulin Pump ◽

Insulin Pump Therapy ◽

Pump Therapy

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Accurate Carbohydrate Counting Is an Important Determinant of Postprandial Glycemia in Children and Adolescents With Type 1 Diabetes on Insulin Pump Therapy

Journal of Diabetes Science and Technology ◽

10.1177/1932296816679850 ◽

2016 ◽

Vol 11 (4) ◽

pp. 753-758 ◽

Cited By ~ 15

Author(s):

Asma Deeb ◽

Ahlam Al Hajeri ◽

Iman Alhmoudi ◽

Nico Nagelkerke

Keyword(s):

Type 1 Diabetes ◽

Children And Adolescents ◽

Insulin Pump ◽

Postprandial Glucose ◽

Meal Size ◽

Insulin Pump Therapy ◽

Pump Therapy ◽

Postprandial Glycemia ◽

The Impact

Background: Carbohydrate (CHO) counting is a key nutritional intervention utilized in the management of diabetes to optimize postprandial glycemia. The aim of the study was to examine the impact of accuracy of CHO counting on the postprandial glucose in children and adolescents with type 1 diabetes on insulin pump therapy. Methods: Children/adolescents with type 1 diabetes who were on insulin pump therapy for a minimum of 6 months are enrolled in the study. Patients were instructed to record details of meals consumed, estimated CHO count per meal, and 2-hour postprandial glucose readings over 3-5 days. Meals’ CHO contents were recounted by an experienced clinical dietician, and those within 20% of the dietician’s counting were considered accurate. Results: A total of 30 patients (21 females) were enrolled. Age range (median) was 8-18 (SD 13) years. Data of 247 meals were analyzed. A total of 165 (67%) meals’ CHO contents were accurately counted. Of those, 90 meals (55%) had in-target postprandial glucose ( P < .000). There was an inverse relationship between inaccurate CHO estimates and postprandial glucose. Of the 63 underestimated meals, 55 had above-target glucose, while 12 of the 19 overestimated meals were followed by low glucose. There was no association between accuracy and meal size (Spearman’s rho = .019). Conclusion: Accuracy of CHO counting is an important determining factor of postprandial glycemia. However, other factors should be considered when advising on prandial insulin calculation. Underestimation and overestimation of CHO result in postprandial hyperglycemia and hypoglycemia, respectively. Accuracy does not correlate with meal size.

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