medwireNews: Use of an insulin pump is not associated with better glycemic control than multiple daily injections (MDI) among children and adolescents with type 1 diabetes, indicate real-world study results.
The researchers used the SWEDIABKIDS register to evaluate data from all individuals aged 0–17 years with type 1 diabetes in Sweden between 2011 and 2016, equating to 35,624 person–years.
Anna-Lena Fureman (Umeå University, Sweden) and co-authors report a “general reduction” in glycated hemoglobin (HbA1c) levels over the study period regardless of the method of insulin delivery, without an increase in rates of severe hypoglycemia, and an increase in rates of insulin pump use over time.
Across the different age and sex groups the overall decrease in average HbA1c levels was approximately 0.5% (2–5 mmol/mol) from 2011 to 2016, while the proportion of individuals using insulin pumps increased from 41% to 60% in girls and from 35% to 56% in boys.
Fureman et al say that average HbA1c levels were approximately 0.1% lower among children and adolescents using insulin pumps versus MDI in 2011. When individuals were categorized by age, sex, and baseline HbA1c, there were no significant differences in average HbA1c levels with insulin pumps versus MDI use, with the exception of two subgroups.
Among those with HbA1c levels above 8.7% (72 mmol/mol) at baseline, insulin pump use was associated with lower HbA1c than MDI, with average levels of 9.2% versus 9.4% (77.4 vs 79.1 mmol/mol) in 2011 and 9.3% versus 9.5% (78.5 vs 80.5 mmol/mol) in 2016.
Insulin pump users had higher average HbA1c levels than MDI users among boys aged 13–17 years, at 8.2% versus 7.9% (66.3 vs 63.3 mmol/mol) in 2011 and 7.7% versus 7.5% (60.3 vs 58.2 mmol/mol) in 2016.
Although these differences were statistically significant at most timepoints, the researchers say that the decreases in HbA1c associated with insulin pump use were “minute” and had “little clinical relevance.”
However, they write in Pediatric Diabetes that insulin pump use “may nevertheless be worthwhile based on treatment benefits which we have not studied, e.g. improved treatment satisfaction, improved quality of life, facilitating carbohydrate counting, and the coming combination with [continuous glucose monitoring] to create closed-loop systems.”
The team also evaluated body composition, finding that adolescents, particularly girls, tended to have a higher BMI-standard deviation score (SDS) if they used an insulin pump. Average BMI-SDS was significantly higher with pump versus MDI use among girls aged 13–17 years, at 0.97 versus 0.78 in 2011 and 0.98 versus 0.80 in 2016.
“One explanation could be that girls with a high BMI-SDS might have an insulin resistance, which can lead to a higher HbA1c prompting healthcare practitioners to provide them with [insulin pump] treatment in an attempt to improve their metabolic control,” speculate the researchers.
They add: “If this is the case, those involved in health care delivery to children with type 1 diabetes should explore ways to prevent avoidable increases in BMI through support to patients and families, for example healthy food recommendations and encouragement to do physical activity.”
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Pediatr Diabetes 2021; doi:10.1111/pedi.13217