Insulin pump use can improve diabetes management for adults and children with type 1 diabetes (T1D) by improving glycemic control, decreasing severe hypoglycemia episodes, and improving quality of life. 1-13 In 1 meta-analysis, hemoglobin A1c (HbA1c) and quality of life were improved in adults with T1D using pumps compared to multiple daily injections. 14,15 In this study, described in an AHRQ technical report as well as a separate scientific report, the effects on glycemic control were more equivocal in children and adolescents, but there was a greater improvement in glycemic control in those with higher HbA1c. 14,15 Despite the potential benefits of insulin pumps, a small but significant proportion of pump users discontinue pump use over time. 12,16-22 In prior studies, factors associated with pump discontinuation in adolescents and young adults included shorter duration of pump use, age (highest discontinuation rates in adolescents 10-15 years of age), gender (higher discontinuation rates in females), and overall well-being (higher discontinuation rates among individuals with 663963D STXXX10.

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In 2014, the American Diabetes Association lowered its recommended HbA1c target for children with type 1 diabetes (T1D) from <8.5% for <6 years, <8.0% for 6-<13 years, and <7.5 for 13-<18 years to <7.5% for all ages. To determine if HbA1c changed in response, we compared two cross-sectional cohorts of T1D participants in the United States aged <18 years with T1D duration ≥1 year from the T1D Exchange Clinic Registry. The first cohort (PRE) were participants who enrolled between 2010 and 2012 (n=11,788). The second cohort (POST) were participants with an update between 2016 and 2017 (n=9,234). For each age group, mean HbA1c was compared between the cohorts using a linear regression model adjusted for age, T1D duration, and socioeconomic status (SES). A comparison of the cohorts can be found in Table 1. Demographic and SES characteristics were similar between the cohorts. More participants in the POST cohort were using insulin pumps and CGMs. Mean HbA1c was similar between the two cohorts for those <6 years, though more participants in the POST cohort met the current HbA1c target. For the 6-<13 and 13-<18 age groups, those in the POST cohort had higher mean HbA1c, with fewer meeting the current HbA1c target (p<0.01). Thus, despite the lowering of HbA1c targets, glycemic control remains suboptimal in this population. Disclosure J. Wood: None. C. Boyle: None. M. Quinn: None. J.C. Wong: Research Support; Self; Dexcom, Inc.. Other Relationship; Self; Tidepool Project. M.J. Haller: None. B.A. Nelson: Speaker's Bureau; Self; Dexcom, Inc.. M.J. Haller: None. D. Schatz: None. W.V. Tamborlane: Consultant; Self; AstraZeneca, Boehringer Ingelheim GmbH, Eli Lilly and Company, Medtronic MiniMed, Inc., Novo Nordisk Inc., Sanofi, Takeda Pharmaceuticals U.S.A., Inc.. L. Fox: None. P. Prahalad: None. S. Corathers: None. D.M. Maahs: Advisory Panel; Self; Insulet Corporation. Consultant; Self; Abbott. Research Support; Self; Medtronic, Bigfoot Biomedical, Dexcom, Inc., Insulet Corporation, Roche Diabetes Care Health and Digital Solutions. G.T. Alonso: None. D.J. DeSalvo: Consultant; Self; Dexcom, Inc.. Speaker's Bureau; Self; Insulet Corporation. R. Wadwa: Advisory Panel; Self; Eli Lilly and Company. Research Support; Self; Dexcom, Inc., Xeris Pharmaceuticals, Inc., Novo Nordisk Inc., MannKind Corporation, Bigfoot Biomedical. L. DiMeglio: Advisory Panel; Self; Eli Lilly and Company. Research Support; Self; Dexcom, Inc., Medtronic, Sanofi, Caladrius Biosciences, Inc., Janssen Research & Development, Xeris Pharmaceuticals, Inc., Sanofi.