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. 2023 Jun 1;46(6):1218-1222.
doi: 10.2337/dc22-2121.

Increased Technology Use Associated With Lower A1C in a Large Pediatric Clinical Population

G Todd Alonso  1 , Taylor M Triolo  1 , Halis Kaan Akturk  1 , Meghan E Pauley  1 , Marisa Sobczak  2 , Gregory P Forlenza  1 , Casey Sakamoto  1 , Laura Pyle  1   3 , Brigitte I Frohnert  1
Affiliations

Increased Technology Use Associated With Lower A1C in a Large Pediatric Clinical Population

G Todd Alonso et al. Diabetes Care. .

Abstract

Objective: While continuous glucose monitors (CGMs), insulin pumps, and hybrid closed-loop (HCL) systems each improve glycemic control in type 1 diabetes, it is unclear how the use of these technologies impacts real-world pediatric care.

Research design and methods: We found 1,455 patients aged <22 years, with type 1 diabetes duration >3 months, and who had data from a single center in between both 2016-2017 (n = 2,827) and 2020-2021 (n = 2,731). Patients were grouped by multiple daily injections or insulin pump, with or without an HCL system, and using a blood glucose monitor or CGM. Glycemic control was compared using linear mixed-effects models adjusting for age, diabetes duration, and race/ethnicity.

Results: CGM use increased from 32.9 to 75.3%, and HCL use increased from 0.3 to 27.9%. Overall A1C decreased from 8.9 to 8.6% (P < 0.0001).

Conclusions: Adoption of CGM and HCL was associated with decreased A1C, suggesting promotion of these technologies may yield glycemic benefits.

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Conflict of interest statement

Duality of Interest. G.P.F. conducts research sponsored by Medtronic, Dexcom, Abbott, Tandem, Insulet, Eli Lilly, and Beta Bionics and has been a speaker/consultant/advisory board member for Medtronic, Dexcom, Abbott, Tandem, Insulet, Eli Lilly, and Beta Bionics. H.K.A. received research support from Tandem, Dexcom, Medtronic, Senseonics, Eli Lilly, IM Therapeutics, and REMD Pharmaceuticals and has been a consultant/advisory board member for MannKind, Eli Lilly, and Senseonics. B.I.F. has been an advisory board member for Provention Bio. No other potential conflicts of interest relevant to this article were reported.

Figures

None
Graphical abstract
Figure 1
Figure 1
Changes in technology use among 1,455 patients who were in both the 2016–2017 and 2020–2021 cohorts.
Figure 2
Figure 2
A1C by technology group for all patients, adjusted for insurance, age, diabetes duration, sex, and race/ethnicity. Error bars represent 95% CIs. Asterisks represent significant difference from 2016–2017 group: **P < 0.01, ****P < 0.0001.
Figure 3
Figure 3
A1C by technology group for patients who changed technology groups, adjusted for insurance, age, diabetes duration, sex, and race/ethnicity. Only changes with significant differences are shown. Error bars represent 95% CIs. Asterisks represent significant difference from the 2016–2017 group: *P < 0.05, ****P < 0.0001.
See this image and copyright information in PMC

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