Time in Range in Children with Type 1 Diabetes Using Treatment Strategies Based on Nonautomated Insulin Delivery Systems in the Real World: Diabetes Technology and Therapeutics

V. Cherubini, R. Bonfanti, A. Casertano, E. De Nitto, A. Iannilli, F. Lombardo, G. Maltoni, M. Marigliano, M. Bassi, N. Minuto, E. Mozzillo, I. Rabbone, N. Rapini, A. Rigamonti, G. Salzano, A. Scaramuzza, R. Schiaffini, D. Tinti, S. Toni, L. ZagaroliS. Zucchini, C. Maffeis, R. Gesuita

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Glucose sensors consist of real-time continuous glucose monitoring (rtCGM) and intermittently scanned CGM (isCGM). Their clinical use has been widely increasing during the past 5 years. The aim of this study is to evaluate percentage of time in range (TIR) in a large group of children with type 1 diabetes (T1D) using glucose sensors with nonautomated insulin delivery systems, in a real-world setting. Methods: An 11-center cross-sectional study was conducted during January-May 2019. Children with T1D 1 year, treated with multiple daily injections (MDI) or nonautomated insulin pump (IP), were recruited consecutively. Clinical data, HbA1c measurement, and CGM downloaded data were collected by each center and included in a centralized database for the analysis. Glucose metrics of four treatment strategies were analyzed: isCGM-MDI, rtCGM-MDI, isCGM-IP, and rtCGM-IP. Results: Data from 666 children with T1D (51% male and 49% female), median age 12 years, diabetes duration 5 years, were analyzed. An rtCGM was used by 51% of the participants, and a nonautomated IP by 46%. For isCGM-MDI, rtCGM-MDI, isCGM-IP, and rtCGM-IP, the median TIR 70-180 mg/dL values were 49%, 56%, 56%, and 61% (P < 0.001), respectively; HbA1c 7.6%, 7.5%, 7.3%, and 7.3% (P < 0.001), respectively. Use of rtCGM was associated with significant lower time below target range 180 mg/dL and lower HbA1c. If there are no barriers, an upgrade of the treatment strategy with a higher performing technology should be offered to all children who do not achieve blood glucose metrics within the suggested range. © Copyright 2020, Mary Ann Liebert, Inc.
Original languageEnglish
Pages (from-to)509-515
Number of pages7
JournalDiabetes Technol. Ther.
Volume22
Issue number7
DOIs
Publication statusPublished - 2020

Keywords

  • Coefficient of variation
  • Real-world evaluation
  • Time above range, %
  • Time below range
  • Time in range
  • carbohydrate
  • glucose
  • hemoglobin A1c
  • insulin aspart
  • insulin degludec
  • insulin glargine
  • insulin glulisine
  • insulin lispro
  • Article
  • blood glucose monitoring
  • child
  • clinical assessment
  • clinical evaluation
  • clinical study
  • cross-sectional study
  • disease duration
  • female
  • human
  • insulin dependent diabetes mellitus
  • major clinical study
  • male
  • multicenter study
  • obstetric delivery
  • outcome assessment
  • priority journal
  • time in range
  • time to treatment
  • treatment duration

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