O-31: Automated insulin delivery in Ukrainian war refugee children with type 1 diabetes: a 3-year follow-up
V Neuman, L Plachy, S Pruhova, S Kolouskova, B Obermannova, L Drnkova, S A Amaratunga, P Konecna, J Vyzralkova, P Venhacova, R Pomahacova, P Paterova, L Stichova, J Skvor, K Kocourkova, M Romanova, J Vosahlo, J Strnadel, K Polockova, J Knizek, D Neumann, M Slavenko, Z SumnikAbstract
Introduction
Following the war in Ukraine, Europe received a huge number of war refugees including children with type 1 diabetes (CwD).
Objectives
The aim was to describe diabetes control and changes in treatment modalities during the first three years after arrival.
Methods
A total of 143 (70 M, 73 F) CwD were recruited into this longitudinal observational study between March 2022 and June 2025 in 9 tertiary pediatric diabetes centers. Their mean age was 11.8±3.8 years and T1D duration was 4.3±3.7 years. Following data were collected yearly: treatment type, CGM use, anthropometrics, HbA1c and CGM metrics. Statistical inference was performed using linear mixed models with random intercept on the participant level adjusting for sex, age, timepoint, age at T1D onset and therapy type. The participants were matched to controls from the nation-wide Czech National Pediatric Diabetes Registry matched for age, T1D duration, sex and type of treatment.
Results
The mean HbA1c decreased significantly from 63.5±21.5 mmol/mol (8.0±4.1%) at baseline to 56.8±16.0 mmol/mol (6.9±3.6%) at 3 years (P<0.001). We have observed a massive uptake of CGM from 46.4% at baseline to 95.5% at 3 years (P<0.001). The use of CSII increased from 8.0% at baseline (no AID systems) to 63.6% (only AID systems) at 3 years (P<0.001). The trend in HbA1c decrease was significantly different with regards to therapy type - the estimated effect of AID initiation being −5.39 mmol/mol (95% CI −10.12 to −0.65 mmol/mol) (P=0.003). The TIR of CwD from Ukraine who initiated AID was not significantly different from their matched controls from non-migrant background at 3 years (73.0 vs. 71.0%, P=0.420). Conversely, CwD on MDI had significantly higher TIR than their matched peers (52.0 vs. 63.0%, P=0.003).
Conclusions
We observed a significant improvement of T1D control among war refugee CwD during the first three years of their stay in Czechia. Our data emphasize the crucial role of AID in improving T1D control in all CwD, regardless of their socioeconomic background.