P-334: Comparative early real-world glycemic response to automated insulin delivery in children, adolescents, and adults with type 1 diabetes: a Brazilian cohort study
S Chen, M Gabbay, M Scharf, M Punales, P Fulgencio, I Van der Linden, P Cole Brugnera, R De Azeredo Siqueira, L E CalliariAbstract
Introduction
Automated insulin delivery (AID) improves glycemic control in individuals with type 1 diabetes; however, comparative real-world data between pediatric and adult populations remain limited, particularly in middle-income countries.
Objectives
To compare the early glycemic response to AID in children/adolescents and adults with type 1 diabetes.
Methods
We conducted a real-world study of 114 individuals with type 1 diabetes initiating AID. Glycemic metrics in manual mode (baseline) were compared with those after 30 days of Auto Mode. Participants were stratified into children/adolescents (<18 years, n=41, 12.8±3.4 years) and adults (≥18 years, n=73, 36.2±12.4 years). Outcomes were time in range (TIR, 70–180 mg/dL), time above range (TAR >180 and >250 mg/dL), time below range (TBR <70 and <54 mg/dL), and coefficient of variation (CV). Between-group differences were assessed using longitudinal interaction analyses.
Results
The time in range at baseline was lower in the younger group than in adults (61.0% vs 70.9%; p=x). After 30 days of AID, TIR improved significantly in both groups, with a greater absolute increase in children/adolescents (+13.1% vs+8.1%; p=0.021).Reductions in hyperglycemia were also greater in the younger group, TAR >180 mg/dL (−8.3 vs−5.4 %; p=0.036) and a trend toward greater reduction in TAR >250 mg/dL (−5.5 vs−2.8 %; p=0.054), respectively in children and adults. TBR <70 mg/dL decreased modestly in both groups without significant difference between-group (p=0.39).Clinically significant hypoglycemia remained very low and stable, with TBR <54 mg/dL changing from 0.34% to 0.40% in children/adolescents and from 0.37% to 0.35% in adults (interaction p=0.72). No difference between CV was evidence between groups or baseline and 30 days after AID(p=0.63)
Conclusions
In this Brazilian real-world cohort, children and adolescents with type 1 diabetes with AID had greater improvement in time in range and time spent in hyperglycemia than adults without increased clinically significant hypoglycemia.