P-511: Automated insulin delivery systems in children and adolescents with type 1 diabetes: real-world data from a public referral center
B Tschiedel, P Mondadori, S Toss, M Bressiani, A Fornari, M PuñalesAbstract
Introduction
Automated insulin delivery (AID) systems demonstrated clinical benefits in type 1 diabetes (T1D) individuals, including increases in time in range (TIR) in 10–15%, reduction in hypoglycemic events—particularly severe hypoglycemia—and decreases in glycated hemoglobin (HbA1c).
Objectives
To evaluate glycemic metrics in AID systems users in a public tertiary referral center.
Methods
A cross-sectional study included 69 individuals with T1D using AID systems (59.4% female). Glycemic metrics were defined according to international consensus recommendations for TIR. Continuous variables are presented as mean ± standard deviation or median and interquartile range (IQR), as appropriate.
Results
The median current age was 17.9 years (IQR: 11.5–29.1), and the median age at T1D diagnosis was 12.3 years (IQR: 8.3–18.5), with 23% diagnosed before 7 years of age. The median age at AID initiation was 16.3 years (IQR: 9.6–26.7). Prior insulin pump therapy was reported in 69.6% of participants, initiated at a median age of 13.1 years (IQR: 6.7–19.8), with a median duration of 6.1 years (IQR: 2.4–8.8) before transitioning to AID. Glycemic metrics demonstrated a mean TIR of 72.7 ± 9.4%. Time above range (TAR >180 mg/dL) was 19.0 ± 7.0%, and TAR >250 mg/dL was 5.6 ± 4.7%. Median time below range (TBR <70 mg/dL) was 1.0% (IQR: 1–3%), and TBR <54 mg/dL was 0% (IQR: 0–1%). Mean sensor utilization was 87.0 ± 17.7%. The mean glucose management indicator (GMI) was 6.7 ± 1.2%, and mean HbA1c was 7.1 ± 0.9%. Optimized AID settings were observed in 58.0%. The primary indications for AID initiation were glycemic variability (62.2%) and hypoglycemia (21.7%), with a high proportion of severe hypoglycemic episodes (53.3% among those with hypoglycemia).
Conclusions
In this real-world cohort from a tertiary diabetes center, AID systems was increased glycemic control, with increased TIR and minimal exposure to hypoglycemia. These findings reinforce clinical effectiveness of AID in management of pediatric T1D within a public healthcare setting.