Time in range in children with type 1 diabetes using treatment strategies based on non-automated insulin delivery systems in the real-world.

Background Glucose sensors consist of real time continuous glucose monitoring (rtCGM) and intermittently scanned CGM (isCGM). Their clinical use has been widely increasing during last five 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 non-automated insulin delivery systems, in a real-world setting. Methods An eleven-centre cross-sectional study was conducted during January-May 2019. Children with T1D under the age of 18 years, all using rtCGM or isCGM for more than one year, treated with multiple daily injections (MDI) or non-automated insulin pump (IP) were recruited consecutively. Clinical data, HbA1c measurement, and CGM downloaded data were collected by each centre and included in a centralised database for the analysis. Glucose metrics of four treatment strategies were analysed: isCGM-MDI, rtCGM-MDI, isCGM-IP, rtCGM-IP. Results Data from 666 children with T1D (51% male; 49% female), median age 12 years, diabetes duration 5 years, were analysed. A rtCGM was used by 51% of the participants, and a non-automated insulin pump (IP) by 46%. For isCGM-MDI, rtCGM-MDI, isCGM-IP, and rtCGM-IP, the median time-in-range 70-180 mg/dl (TIR) values were 49%, 56%, 56%, 61% (p<0.001) respectively; HbA1c 7.6%, 7.5%, 7.3%, 7.3% (p<0.001), respectively. Use of rtCGM was associated with significant lower time below target range <70 mg/dl (TBR) and reduced the percentage coefficient of variation of glucose (%CV), independently by the insulin-delivery system used. Conclusions Among non-automated insulin-delivery strategies, simultaneous use of rtCGM and IP was associated with higher percent of TIR, lower time above range >180 mg/dl (TAR) 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.