Association of the use of diabetes technology with<scp>HbA1c</scp>and<scp>BMI‐SDS</scp>in an international cohort of children and adolescents with type 1 diabetes: The<scp>SWEET</scp>project experience

Marigliano, Marco; Eckert, Alexander J.; Guness, Pravesh Kumar; Herbst, Antje; Smart, Carmel E.; Witsch, Michael; Maffeis, Claudio

doi:10.1111/pedi.13274

Cited by 22 publications

(9 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…11 The prevalence of diabetes technology use, such as insulin pumps and continuous glucose monitors (CGMs), by youth with diabetes has risen dramatically in recent years. 2,12 Youth who manage their diabetes using an insulin pump experience significantly improved A1C levels, 1,2,13,14 fewer DKA episodes, 12 and lower rates of diabetic retinopathy. 13 Similarly, youth who use a CGM have lower A1C 2 and less fear of severe hypoglycemia.…”

mentioning

confidence: 99%

Racial Disparities in Technology Use in Children With Type 1 Diabetes: A Qualitative Content Analysis of Parents’ Perspectives

Howe

Morone

Hawkes

et al. 2023

The Science of Diabetes Self-Management and Care

View full text Add to dashboard Cite

Purpose: The purpose of the study was to describe differences in non-Hispanic Black (NHB) and non-Hispanic White (NHW) parents’ perceptions of factors that influence the use of diabetes technology. Methods: Focus groups were conducted with parents of NHB and NHW children at a pediatric diabetes center in the Northeast United States. Kilbourne’s health disparities framework informed the focus group guide and a priori coding for directed content analysis. Further analysis allowed subcategories to emerge inductively. Results: Twenty-one parents participated. Five subcategories emerged, describing differences in NHB and NHW parent decisions regarding diabetes technology: (1) child’s choice, (2) shame versus pride, (3) pros and cons of technology, (4) time frame, and (5) blood glucose indications of readiness. NHB parents feared technology malfunction, worried that visible devices could worsen experienced stigma of diabetes diagnosis, and described the diabetes team as gatekeepers, who changed eligibility criteria for diabetes technology use for their research purposes. In contrast, NHW parents reported diabetes team expectation of diabetes technology use and did not report provider-related barriers. Conclusion: This study adds to existing literature advancing our understanding of the patient and provider mechanisms underlying racial disparities in diabetes technology use. This understanding may guide development of interventions focused on patients, providers, and structural factors to improve equity in use of diabetes technology by youth with type 1 diabetes.

show abstract

mentioning

confidence: 99%

Racial Disparities in Technology Use in Children With Type 1 Diabetes: A Qualitative Content Analysis of Parents’ Perspectives

Howe

Morone

Hawkes

et al. 2023

The Science of Diabetes Self-Management and Care

View full text Add to dashboard Cite

show abstract

“…While currently there are no data from RCTs comparing real-time and intermittently scanned CGM use in youths with type 1 diabetes, real-world data could provide some understanding regarding the association of glycemic outcomes with different treatment modalities in routine clinical care. 29 , 32 , 33 In all evaluated treatment modalities, a much higher proportion of participants achieved time below range targets (45%-70%), compared to time in range and time above range clinical targets (10%-25%). There is accumulating evidence that youths with type 1 diabetes and parents of younger children with type 1 diabetes may use CGM to focus on avoiding hypoglycemia rather than improving time in range and preventing hyperglycemia.…”

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 98%

Association of Achieving Time in Range Clinical Targets With Treatment Modality Among Youths With Type 1 Diabetes

et al. 2023

Self Cite

View full text Add to dashboard Cite

ImportanceContinuous glucose monitoring (CGM) devices have demonstrated efficacy in adults and more recently in youths and older adults with type 1 diabetes. In adults with type 1 diabetes, the use of real-time CGM compared with intermittently scanned CGM was associated with improved glycemic control, but there are limited data available for youths.ObjectiveTo assess real-world data on achievement of time in range clinical targets associated with different treatment modalities in youths with type 1 diabetes.Design, Setting, and ParticipantsThis multinational cohort study included children, adolescents, and young adults younger than 21 years (hereinafter referred to collectively as youths) with type 1 diabetes for a duration of at least 6 months who provided CGM data between January 1, 2016, and December 31, 2021. Participants were enrolled from the international Better Control in Pediatric and Adolescent Diabetes: Working to Create Centers of Reference (SWEET) registry. Data from 21 countries were included. Participants were divided into 4 treatment modalities: intermittently scanned CGM with or without insulin pump use and real-time CGM with or without insulin pump use.ExposuresType 1 diabetes and the use of CGM with or without an insulin pump.Main Outcomes and MeasuresProportion of individuals in each treatment modality group achieving recommended CGM clinical targets.ResultsAmong the 5219 participants (2714 [52.0%] male; median age, 14.4 [IQR, 11.2-17.1] years), median duration of diabetes was 5.2 (IQR, 2.7-8.7) years and median hemoglobin A1c level was 7.4% (IQR, 6.8%-8.0%). Treatment modality was associated with the proportion of individuals achieving recommended clinical targets. Adjusted for sex, age, diabetes duration, and body mass index standard deviation score, the proportion achieving the recommended greater than 70% time in range target was highest with real-time CGM plus insulin pump use (36.2% [95% CI, 33.9%-38.4%]), followed by real-time CGM plus injection use (20.9% [95% CI, 18.0%-24.1%]), intermittently scanned CGM plus injection use (12.5% [95% CI, 10.7%-14.4%]), and intermittently scanned CGM plus insulin pump use (11.3% [95% CI, 9.2%-13.8%]) (P &lt; .001). Similar trends were observed for less than 25% time above (real-time CGM plus insulin pump, 32.5% [95% CI, 30.4%-34.7%]; intermittently scanned CGM plus insulin pump, 12.8% [95% CI, 10.6%-15.4%]; P &lt; .001) and less than 4% time below range target (real-time CGM plus insulin pump, 73.1% [95% CI, 71.1%-75.0%]; intermittently scanned CGM plus insulin pump, 47.6% [95% CI, 44.1%-51.1%]; P &lt; .001). Adjusted time in range was highest among real-time CGM plus insulin pump users (64.7% [95% CI, 62.6%-66.7%]). Treatment modality was associated with the proportion of participants experiencing severe hypoglycemia and diabetic ketoacidosis events.Conclusions and RelevanceIn this multinational cohort study of youths with type 1 diabetes, concurrent use of real-time CGM and an insulin pump was associated with increased probability of achieving recommended clinical targets and time in range target as well as lower probability of severe adverse events compared with other treatment modalities.

show abstract

“…The authors of The SWEET Registry demonstrated that switching from the multiple daily insulin injection to the continuous subcutaneous insulin infusion is significantly associated with an improvement in glycemic control but also with an increase in BMI in more than 4,000 youths with T1D ( 15 ). Interestingly, there are findings suggesting that in cases of co-occurring obesity and type 1 diabetes, making some changes to current therapy and using new long acting analogues as basal insulins, such as detemir, degludec and glar-300 may slightly prevent the weight gain associated with intensive insulin therapy ( 83 ).…”

Section: Obvious and Less Obvious Causes Of Obesity In Type 1 Diabetesmentioning

confidence: 99%

“…Excessive body weight has been linked to T1D from its very beginning, numerous studies presumed its role in autoimmune diabetes pathogenesis ( 10 , 11 ). Apart from a great number of environmental factors of overweight and obesity in T1D such as dietary mistakes, fear of insulin induced hypoglycaemia resulting in excessive carbohydrates intake and lack of exercise, sedentary lifestyle ( 12 ), authors frequently list modern patterns of intensive insulin therapy itself ( 13 – 15 ). Obesity can contribute to the challenges in attaining optimal glycaemic control ( 16 ).…”

Section: Introductionmentioning

confidence: 99%

Multi-Faceted Influence of Obesity on Type 1 Diabetes in Children – From Disease Pathogenesis to Complications

et al. 2022

View full text Add to dashboard Cite

The prevalence of overweight and obesity among youth patients with diabetes type 1 is increasing. It is estimated, that even up to 35% of young patients with this type of diabetes, considered so far to be characteristic for slim figure, are overweight or even obese. General increase of obesity in children’s population complicates differential diagnosis of the type of diabetes in youths. Coexistence of obesity has clinical implications for all stages of diabetes course. It is confirmed that obesity is the risk factor for autoimmune diabetes, and is connected with the earlier onset of diabetes in predisposed patients. Many diabetic patients with obesity present additional risk factors for macroangiopathy, and are recognised to present metabolic syndrome, insulin resistance, and typical for diabetes type 2 - polycystic ovary syndrome, or non-alcoholic fatty liver disease. The prevalence of obesity rises dramatically in adolescence of diabetic child, more often in girls. It has negative impact on metabolic control, glycaemic variability and insulin demand. The risk for microangiopathic complications increases as well. The treatment is difficult and includes not only insulinotherapy and non-pharmacological trials. Recently treatment of insulin resistance with biguanids, and treatment with typical for type 2 new diabetes drugs like GLP-1 analogues, SGLT-2 receptor inhibitors, or even cases of bariatric surgery also has been reported.

show abstract

Association of the use of diabetes technology withHbA1candBMI‐SDSin an international cohort of children and adolescents with type 1 diabetes: TheSWEETproject experience

Cited by 22 publications

References 47 publications

Racial Disparities in Technology Use in Children With Type 1 Diabetes: A Qualitative Content Analysis of Parents’ Perspectives

Racial Disparities in Technology Use in Children With Type 1 Diabetes: A Qualitative Content Analysis of Parents’ Perspectives

Association of Achieving Time in Range Clinical Targets With Treatment Modality Among Youths With Type 1 Diabetes

Multi-Faceted Influence of Obesity on Type 1 Diabetes in Children – From Disease Pathogenesis to Complications

Contact Info

Product

Resources

About