TY - JOUR
T1 - Time in Range in Children with Type 1 Diabetes Using Treatment Strategies Based on Nonautomated Insulin Delivery Systems in the Real World
AU - Cherubini, Valentino
AU - Bonfanti, Riccardo
AU - Casertano, Alberto
AU - De Nitto, Elena
AU - Iannilli, Antonio
AU - Lombardo, Fortunato
AU - Maltoni, Giulio
AU - Marigliano, Marco
AU - Bassi, Marta
AU - Minuto, Nicola
AU - Mozzillo, Enza
AU - Rabbone, Ivana
AU - Rapini, Novella
AU - Rigamonti, Andrea
AU - Salzano, Giuseppina
AU - Scaramuzza, Andrea
AU - Schiaffini, Riccardo
AU - Tinti, Davide
AU - Toni, Sonia
AU - Zagaroli, Luca
AU - Zucchini, Stefano
AU - Maffeis, Claudio
AU - Gesuita, Rosaria
N1 - Publisher Copyright:
© Copyright 2020, Mary Ann Liebert, Inc.
PY - 2020/7
Y1 - 2020/7
N2 - Background: Glucose sensors consist of real-time continuous glucose monitoring (rtCGM) and intermittently scanned CGM (isCGM). Their clinical use has been widely increasing during the past 5 years. The aim of this study is to evaluate percentage of time in range (TIR) in a large group of children with type 1 diabetes (T1D) using glucose sensors with nonautomated insulin delivery systems, in a real-world setting. Methods: An 11-center cross-sectional study was conducted during January-May 2019. Children with T1D <18 years, all using rtCGM or isCGM for >1 year, treated with multiple daily injections (MDI) or nonautomated insulin pump (IP), were recruited consecutively. Clinical data, HbA1c measurement, and CGM downloaded data were collected by each center and included in a centralized database for the analysis. Glucose metrics of four treatment strategies were analyzed: isCGM-MDI, rtCGM-MDI, isCGM-IP, and rtCGM-IP. Results: Data from 666 children with T1D (51% male and 49% female), median age 12 years, diabetes duration 5 years, were analyzed. An rtCGM was used by 51% of the participants, and a nonautomated IP by 46%. For isCGM-MDI, rtCGM-MDI, isCGM-IP, and rtCGM-IP, the median TIR 70-180 mg/dL values were 49%, 56%, 56%, and 61% (P < 0.001), respectively; HbA1c 7.6%, 7.5%, 7.3%, and 7.3% (P < 0.001), respectively. Use of rtCGM was associated with significant lower time below target range <70 mg/dL and reduced the percentage coefficient of variation of glucose (%CV), independently by the insulin delivery system used. Conclusions: Among nonautomated insulin delivery strategies, simultaneous use of rtCGM and IP was associated with higher percentage of TIR, lower time above range >180 mg/dL and lower HbA1c. If there are no barriers, an upgrade of the treatment strategy with a higher performing technology should be offered to all children who do not achieve blood glucose metrics within the suggested range.
AB - Background: Glucose sensors consist of real-time continuous glucose monitoring (rtCGM) and intermittently scanned CGM (isCGM). Their clinical use has been widely increasing during the past 5 years. The aim of this study is to evaluate percentage of time in range (TIR) in a large group of children with type 1 diabetes (T1D) using glucose sensors with nonautomated insulin delivery systems, in a real-world setting. Methods: An 11-center cross-sectional study was conducted during January-May 2019. Children with T1D <18 years, all using rtCGM or isCGM for >1 year, treated with multiple daily injections (MDI) or nonautomated insulin pump (IP), were recruited consecutively. Clinical data, HbA1c measurement, and CGM downloaded data were collected by each center and included in a centralized database for the analysis. Glucose metrics of four treatment strategies were analyzed: isCGM-MDI, rtCGM-MDI, isCGM-IP, and rtCGM-IP. Results: Data from 666 children with T1D (51% male and 49% female), median age 12 years, diabetes duration 5 years, were analyzed. An rtCGM was used by 51% of the participants, and a nonautomated IP by 46%. For isCGM-MDI, rtCGM-MDI, isCGM-IP, and rtCGM-IP, the median TIR 70-180 mg/dL values were 49%, 56%, 56%, and 61% (P < 0.001), respectively; HbA1c 7.6%, 7.5%, 7.3%, and 7.3% (P < 0.001), respectively. Use of rtCGM was associated with significant lower time below target range <70 mg/dL and reduced the percentage coefficient of variation of glucose (%CV), independently by the insulin delivery system used. Conclusions: Among nonautomated insulin delivery strategies, simultaneous use of rtCGM and IP was associated with higher percentage of TIR, lower time above range >180 mg/dL and lower HbA1c. If there are no barriers, an upgrade of the treatment strategy with a higher performing technology should be offered to all children who do not achieve blood glucose metrics within the suggested range.
KW - Coefficient of variation
KW - Real-world evaluation
KW - Time above range, %
KW - Time below range
KW - Time in range
UR - https://www.scopus.com/pages/publications/85086652047
U2 - 10.1089/dia.2020.0031
DO - 10.1089/dia.2020.0031
M3 - Article
SN - 1520-9156
VL - 22
SP - 509
EP - 515
JO - Diabetes Technology and Therapeutics
JF - Diabetes Technology and Therapeutics
IS - 7
ER -
