medwireNews: Glycemic control improved significantly in children with type 1 diabetes between 2013 and 2022, coinciding with increased use of diabetes technology, international registry data show.
“However, most children being treated for type 1 diabetes in this study do not meet ISPAD [International Society for Pediatric and Adolescent Diabetes] and national glycaemic targets,” write Anthony Zimmermann (Lyell McEwin Hospital, Adelaide, South Australia) and co-authors in The Lancet Diabetes & Endocrinology.
They analyzed data for 109,494 children with type 1 diabetes with a duration of longer than 3 months from eight national registries and a further 35,590 from the international SWEET initiative, which includes participants from more than 60 countries.
In 2022, the mean age of participants in each registry ranged from 12.3 years to 13.2 years, and the median duration of type 1 diabetes ranged from 4.4 years to 5.5 years.
The researchers report that the aggregated mean glycated hemoglobin (HbA1c) across all registries decreased significantly from 8.2% (66.5 mmol/mol) in 2013 to 7.6% (59.4 mmol/mol) in 2022.
The aggregated mean proportion of participants who had achieved HbA1c targets of less than 7.0% (<53.0 mmol/mol) increased significantly from 19.0% to 38.8% during the same period, while the proportion with an HbA1c above 9.0% (>75.0 mmol/mol) decreased significantly from 24.1% in 2013 to 13.1% in 2022.
In line with this, the proportion of participants using an insulin pump rose from 42.9% in 2013 to 60.2% in 2022 and the proportion using continuous glucose monitoring (CGM) increased from 18.7% to 81.7%, respectively. Both changes were statistically significant, but the researchers found that insulin pump use “varied greatly between registries.”
They write: “We identified differences in glycaemic outcomes between registries, which might be due to access to diabetes technology, particularly continuous glucose monitoring, but this does not explain all the variability observed between registries.”
Zimmermann et al also comment that the improvements in glycemic outcomes were “accompanied by a consistent pattern across the registries of lower event rates for diabetic ketoacidosis and severe hypoglycaemia.”
Specifically, the aggregate event rate of diabetic ketoacidosis was 3.1 events per 100 person–years in 2013 compared with 2.2 events per 100 person–years in 2022. The rates of severe hypoglycemia were a corresponding 3.0 and 1.7 events per 100 person–years.
Zimmermann and team conclude: “These results can be used by advocates for paediatric diabetes management in all countries to promote equality in diabetes care and access to diabetes technology.”
They add: “Future advances in diabetes management are needed if further improvements in glycaemic outcomes are to be achieved for children with type 1 diabetes.”
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Lancet Diabetes Endocrinol 2024; doi:10.1016/S2213-8587(24)00279-1
