Type 1 diabetes

Glycaemic data supports case to make diabetes technology accessible to people of all ages with T1D

Children and adolescents with type 1 diabetes using either an insulin pump, CGM, or both, have lower HbA1c and fewer DKA episodes than their peers who are not using diabetes technology, a new study suggests.

Data from the international SWEET registry, comprising more than 25,000 participants across 101 centres, supports Australia’s CGM program for young people, according to an Australian co-author of the study.

It also suggests that all Australians with type 1 diabetes would benefit from better access to technology, says Dr Peter Goss, a paediatrician in Geelong, Victoria and chair of the Australian Paediatric Society Diabetes Committee.

“This is a very important study and gives the Federal Government clear direction on cost effective strategies for reducing diabetes complications, hence saving lives. There is no reason that the benefits of diabetes technology cannot be extended across all age groups living with type 1 diabetes,” Dr Goss said in a statement.

“The health benefits of better diabetes control and less DKA or severe low blood glucose levels, both of which require expensive hospitalisation, screams out to make insulin pumps and CGMs more accessible to people all ages living with type 1 diabetes.”

Dr Goss said the current approach to diabetes technology was “a piecemeal, ad hoc approach of private health insurance subsidies, JDRF grants, Federal government full subsidy programs or no assistance.”

“The evidence is becoming very clear. The Federal Government should review the entire model of type 1 diabetes funding to ensure all Australians have access to the best possible management strategies to save lives and reduce expensive and debilitating short- and long-term complications of type 1 diabetes.”

The SWEET registry data 2017-2019, published in Diabetes Care, compared outcomes by treatment group – either injections-no sensor (37.44%), injections + sensor (14.98%), pump-no sensor (17.22%), or pump + sensor (30.35%).

The study found HbA1c was significantly lower for all treatment groups involving diabetes technology when compared with the reference group (injections-no sensor).

For example, the HbA1c target <7.5% was achieved by only 26% of young people in the injections-no sensor group but 40% of the injection + sensor group, 46% of the pump-no sensor group, and 44% of the pump + sensor group.

The proportion of DKA episodes was significantly lower only in participants using a pump – with or without sensor – when compared with the reference group.

“The effect of CGM on preventing DKA seems to be additive to the effect of pump therapy, with the lowest DKA rate observed in the combined pump and sensor group.”

Episodes of severe hypoglycemia were significantly lower only in the pump–no sensor group, compared with the reference group.

The study noted that benefits of using technology persisted when the participants were categorised by age group.

“Our findings show a major evolution in technology use over the past 10 years and a progressive improvement in the attaining of glycemic targets globally,” the investigators concluded.

Disclosure: The study was supported by the SWEET corporate members, namely, Abbott, Boehringer Ingelheim, Dexcom, Insulet, Eli Lilly and Company, Medtronic, and Sanofi. 

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