P-259: Timing of automated insulin delivery system initiation after onset of type 1 diabetes in children and adolescents – a comparison between Germany, Austria, and Luxembourg
E Binder, M Auzanneau, U Schierloh, T Biester, A Galler, M Flury, B Horlebein, A Veigel, S Lanzinger, S HoferAbstract
Introduction
Automated insulin delivery (AID) systems have substantially transformed the management of children and adolescents with type 1 diabetes (T1D) and have been recommended in ISPAD guidelines since 2022.
Objectives
This study assessed differences in the use of diabetes technologies between Germany, Austria, and Luxembourg, with a particular focus on the timing of AID initiation after diagnosis.
Methods
Data from the DPV registry were analyzed for patients diagnosed with T1D between 6 months and 18 years of age. Use of glucose sensors, insulin pumps, and AID systems was evaluated from 2014 to 2024. Among patients using AID for at least 13 months (2019–2024), differences between countries in the timing of AID initiation (≤6 months, 6–12 months, >12 months after insulin start) were analyzed using multinomial logistic regression adjusted for sex, year of initiation, center size, age, HbA1c, diabetic ketoacidosis, and insulin dose at diagnosis. Analyses were stratified by age group.
Results
A total of 45,237 patients were included. In all three countries, use of glucose sensors (up to 96% in 2024), insulin pumps (70% in Germany, 71% in Austria, 85% in Luxembourg), and AID systems (57%, 56%, and 73%, respectively) increased markedly over time. For the AID initiation analysis, 18,248 patients were included. After adjustment, approximately twice as many patients in Austria (28.8% [95% CI: 26.2–31.6%]) and Luxembourg (28.6% [95% CI: 20.5–38.3%]) initiated AID within six months of diagnosis compared to Germany (14.2% [95% CI: 13.6–14.9%]). This pattern was consistent across all age groups.
Conclusions
The use of diabetes technologies increased over time in all three countries. However, significant differences exist in the timing of AID initiation, which occurs more frequently early after diagnosis in Austria and Luxembourg than in Germany. Differences in reimbursement policies, approval pathways, and national health insurance frameworks may contribute and warrant further investigation.