Kids With T1D Doing Better, But Still not Meeting Targets

TOPLINE:

International paediatric type 1 diabetes (T1D) registry data show improvement from 2013 to 2022 in average A1c and the proportion of children with T1D meeting A1c targets, with lower rates of diabetic ketoacidosis and severe hypoglycaemia.

However, even for those with access to specialised diabetes care and technology, many are still not meeting the 2022 glycaemic targets recommended by the International Society for Pediatric and Adolescent Diabetes.

METHODOLOGY:

• A longitudinal analysis of data for all children with T1D of duration > 3 months, from eight national registries in Europe, the United Kingdom, and the United States, and one international initiative (SWEET).
• Between 2013 and 2022, the overall number of children with T1D included in the national registries increased from 47,390 to 109,494, and in SWEET, from 10,840 to 35,590.

TAKEAWAY:

• Mean A1c of all registries dropped during the study period, from 8.2% (66.5 mmol/mol) in 2013 to 7.6% (59.4 mmol/mol) in 2022 (P
• The overall proportion achieving target A1c of P
• Overall, the proportion using insulin pumps rose from 42.9% to 60.2% (P P
• The diabetic ketoacidosis event rate dropped, although non-significantly, from 3.1 to 2.2 events per 100 person-years from 2013 to 2022 (P = .260), and severe hypoglycaemia from 3.0 to 1.7 events per 100 person-years (P = .071), both across most registries.

IN PRACTICE:

“Our study findings confirm improved glycaemic outcomes in children on an international scale. Success was likely to have been influenced by multiple factors including the establishment of the diabetes registries and benchmarking activities, setting stringent HbA1c targets, and the paralleled increase in uptake and access to diabetes technology, particularly CGM, although these factors do not explain all variability,” the authors wrote.

“The event rates of acute diabetes complications seem to be decreasing, a testimony that modern insulins, insulin delivery, glucose-monitoring systems, and approaches to diabetes care are facilitating achievement of glucose levels as near normal as possible without resulting in an increase in severe hypoglycaemia event rates,” they added.

SOURCE:

Conducted by Anthony T. Zimmermann, FRACP, of the Division of Medicine, Lyell McEwin Hospital, Adelaide, Australia, and colleagues, the study was published online on November 29, 2024, in Lancet Diabetes & Endocrinology.

LIMITATIONS:

Data were not pooled (due to multinational data privacy regulations). Data for comparison were not analyed by an independent party. No analysis by insulin treatment regimen or CGM use. Impossible to distinguish use of separate pump/CGM from connected automated systems. CGM metrics not universally available. Reported acute diabetes complications not validated. Varying definitions for severe hypoglycaemia across registries. SWEET is not a population-based registry, and some of those individuals are also in the national registries. All of the registries were located in high-income countries. No data on daily insulin usage.

DISCLOSURES:

Anthony T. Zimmerman has no disclosures, although several co-authors do.