ESPE Abstracts

Background: Managing glucose control in young children with Type 1 Diabetes (T1D) is challenging due to variable insulin needs, sensitivity, and unpredictable eating and activity behaviours. Despite their effectiveness, the majority of the Advanced Hybrid Closed Loop (AHCL) systems is not approved for children under six in many countries of Europe.

Aim: To assess and compare the effectiveness of Multiple Daily Injection (MDI) plus Continuous Glucose Monitoring (CGM) and AHCL, in preschool children with T1D.

Methods: a retrospective, one-year, observational, real-world study was performed involving 54 children with T1D < 6 yrs of age. CGM data over 14 days was downloaded and entered into GlyCalculator3 software at three months intervals (t3,t6,t9,t12).

Results: Patients (33 M/22 F, mean age at diagnosis 2.4 ± 1.2 yrs, mean age at technology start 3.3 ± 1.4 yrs, mean diabetes duration of 1.7 ± 1.1) were categorized into two groups according to the insulin delivery system used: MDI+CGM (31), and AHCL (11). Time In Range (TIR 3.9-10 mmol/L) significantly improved in the AHCL group compared to MDI at all time points (53,6%±14,9 vs 66,2%±7,4, 54,5%±13,4 vs 66,1%±5,2, 53,9% ±15,0 vs 69,2%± 4,1, 53,9%±15,0 vs 69,3%±4,4; p < 0.05 at T3,6,9,12). Similar results have been obtained for Time Above Range (TAR 10 and 13.5 mmol/L). No significant variations were observed across the groups for the Time Below Range (TBR < 3.1-3.9-10 mmol/L). No severe hypoglycemia or diabetic ketoacidosis episodes occurred in our cohort. The glycemic variability indexes (sensor glucose median and glucose management index) demonstrated a statistically significant improvement in mean change between the MDI and AHCL groups at each observational time points. For the AHCL group, the mean GMI was 7.30 ± 0.58 at time 6 (P = 0.026) and showed a progressively significant reduction during follow-up to 6.92± 0.2% at time 9 (p 0.04) and 6.9 ± 0.7% at time 12 although not statistically significant. No significant difference between SAP versus AHCL systems was observed.

Conclusion: AHCL systems significantly improve glucose control and reduce glucose variability in very young children with T1D, suggesting that this system represents a better adequate strategy compared to MDI and SAP.