P-332: Real-world effectiveness of smart pen insulin therapy in adolescents with poorly controlled type 1 diabetes
P Enes, R Alcalá, M Martín-Frías, M Güemes, J ArgenteAbstract
Introduction
Smart insulin pens with bolus calculator, dose reminders, and alerts for missed doses and hyperglycemia correction (Smart MDI) can improve glycemic outcomes and adherence by optimizing insulin dosing through decision support tools
Objectives
We evaluated their effectiveness in adolescents with poorly controlled type 1 diabetes (T1D) in real-world clinical practice
Methods
An observational longitudinal study including 28 pediatric patients with T1D initiating Smart MDI after prior offer and decline of AID therapy. Mean age at initiation was 14.4 ± 3.1 years, with a mean diabetes duration of 5.7 ± 4.8 years; 25% were female. Continuous glucose monitoring metrics were collected at baseline and after 3 months, including time in range (TIR 70-180 mg/dL), time above range (TAR), time below range (TBR), mean glucose, coefficient of variation (CV), glucose management indicator (GMI), HbA1c, and glycemic risk index (GRI)
Results
TIR increased significantly from 50 ± 16% to 65 ± 14% (Δ +15.9%, 95% CI 11.6 to 20.1; p<0.001). Mean glucose decreased from 190 ± 46 to 159 ± 26 mg/dL (Δ −31.4 mg/dL, 95% CI −45.9 to −16.9; p<0.001), accompanied by improvement in HbA1c from 7.9 ± 0.9% to 7.2 ± 0.7% (Δ −0.64%, 95% CI −0.82 to −0.45; p<0.001). TAR>250 mg/dL was markedly reduced (−12.7%,95% CI −19.0 to −6.4; p<0.001). No increase in hypoglycemia was observed, with TBR <70 mg/dL remaining unchanged (3.4 ± 4.2% vs 3.5 ± 3.6%). The GMI and GRI indices improved significantly. The proportion of participants achieving TIR >70% increased from 18% to 55%. After Smart MDI initiation, 39% of patients transitioned to AID systems
Conclusions
Smart MDI significantly improves glycemic control in adolescents with poorly controlled T1D, increasing TIR and reducing hyperglycemia without increasing hypoglycemia. These findings support its implementation in routine clinical practice and highlight its role as a practical step in the intensification of diabetes technology for patients who did not initially opt for an AID system