Start them young: Early diabetes device use leads to better glycaemic control in kids with T1D
In children with newly diagnosed type 1 diabetes (T1D), earlier initiation of devices, such as an insulin pump or a continuous glucose monitor (CGM), improves glycaemic control within the first year of diagnosis, according to a recent study.
“[T]he current data suggest that initiating insulin pump or CGM use close to the time of diagnosis may have beneficial effects on children’s glycated haemoglobin (HbA1c) through 12 months,” said researchers.
In 111 families with a child T1D patient (mean age, 7.51±1.37 years; 47 percent male), the mean time since diagnosis was 4.70±3.28 months. Most of the parents surveyed for the study were mothers (88.1 percent), with a mean age of 36.75±6.27 years. Glycated haemoglobin (HbA1c) was measured at baseline and every 3 months thereafter. [Diabetes Technol Ther 2019;doi:10.1089/dia.2019.0026]
The mean HbA1c level at baseline was 7.65±1.40 percent (60 mmol/mol), with 37.8 percent of children having ≤7.0 percent HbA1c. After 6 months, mean HbA1c grew slightly to 8.05±1.08 percent (64 mmol/mol), while the percentage of children with HbA1c ≤7.0 percent declined to 13.5 percent.
Seventeen percent of the participants were already using insulin pumps before study enrolment. Between baseline and the 6-month follow-up, 35.1 percent initiated use of the device. Of these new users, HbA1c levels dropped in 30.8 percent, remained the same in 2.5 percent and further increased in 66.7 percent.
In independent sample comparisons, patients who started using an insulin pump during the 6-month period after enrolment showed a 0.53-percent lower HbA1c than their no-device counterparts (p=0.01). Those who had been diagnosed with T1D for a shorter time at baseline were also less likely to start using an insulin pump (mean difference, 1.36 months; p=0.03).
In terms of CGM use, 17.1 percent of the participants were already on the device before study enrolment and 25.2 percent initiated before the 6-month visit. HbA1c declined in 40.7 percent, remained the same in 3.7 percent and increased in 55.6 percent in children who initiated use in 6 months after baseline. HbA1c concentrations at follow-up were significantly lower in those who started using the device (mean difference, 0.66 percent; p=0.01).
“The clinical implication of these findings is further support for early introduction of T1D devices in children’s daily management even within the first few months of T1D,” said researchers, noting that future studies are still needed to determine whether early initiation also improves device assimilation and quality of life in this population.
“In addition, as T1D devices continue to advance, future studies need to explore how starting a hybrid closed loop system in children with recent-onset T1D relates to their glycaemic control,” they added.