Glycemic Outcome Associated With Insulin Pump and Glucose Sensor Use in Children and Adolescents With Type 1 Diabetes: Data From the International Pediatric Registry SWEET

OBJECTIVE Insulin delivery methods, glucose-monitoring modalities, and related outcomes were examined in a large, international, diverse cohort of children and adolescents with type 1 diabetes from the Better Control in Pediatric and Adolescent Diabetes: Working to Create Centers of Reference (SWEET) registry. RESEARCH DESIGN AND METHODS Participants with type 1 diabetes of $1 year duration, aged #18 years, and who had documented pump or sensor usage during the period August 2017–July 2019 were stratified into four categories: injections–no sensor (reference); injections + sensor; pump–no sensor; and pump + sensor. HbA_1c and proportion of patients with diabetic ketoacidosis (DKA) or severe hypoglycemia (SH) were analyzed; linear and logistic regression models adjusted for demographics, region, and gross domestic product per capita were applied. RESULTS Data of 25,654 participants were analyzed. The proportions of participants (adjusted HbA_1c data) by study group were as follows: injections–no sensor group, 37.44% (8.72%; 95% CI 8.68–8.75); injections + sensor group, 14.98% (8.30%; 95% CI 8.25–8.35); pump–no sensor group, 17.22% (8.07%; 95% CI 8.03–8.12); and pump + sensor group, 30.35% (7.81%; 95% CI 7.77–7.84). HbA_1c was lower in all categories of participants who used a pump and/or sensor compared with the injections–no sensor treatment method (P < 0.001). The proportion of DKA episodes was lower in participants in the pump + sensor (1.98%; 95% CI 1.64–2.48; P < 0.001) and the pump–no sensor (2.02%; 95% CI 1.64–2.48; P < 0.05) groups when compared with those in the injections–no sensor group (2.91%; 95% CI 2.59–3.31). The proportion of participants experiencing SH was lower in pump–no sensor group (1.10%; 95% CI 0.85–1.43; P < 0.001) but higher in the injections + sensor group (4.25%; 95% CI 3.65–4.95; P < 0.001) compared with the injections–no sensor group (2.35%; 95% CI 2.04–2.71). CONCLUSIONS Lower HbA_1c and fewer DKA episodes were observed in participants using either a pump or continuous glucose monitoring (CGM) or both. Pump use was associated with a lower rate of SH. Across SWEET centers, use of pumps and CGM is increasing. The concomitant use of pump and CGM was associated with an additive benefit.