Differences in Metabolic Control Between Different Insulin Use Patterns in Pediatric Patients with Type 1 Diabetes Through Intermittent Glucose Monitoring.

Introduction: In healthcare centers with limited resources, or for patients who prefer to make continuous changes in their treatment themselves and do not want to rely solely on technology, intermittent glucose monitoring (isCGM) with an insulin pump is a viable option that warrants further study.

Material and methods: prospective single-center study that collected data at 3 months and after isCGM implantation in pediatric patients with Type 1 diabetes, categorized according to their insulin regimen.

Results: We found statistically significant differences in the time in range (TIR) between 70 and 180 mg/dl at 3 months after using the sensor (p = 0.017), although these differences were not maintained at 1 year (p = 0.064). When stricter TIRs (70-140 mg/dl) were analyzed, statistically significant differences were observed at 3 months (p = 0.01) and at 1 year (p = 0.018) in favor of patients using CSII. While 75% of the patients in the CSII group had good control with HbA1c < 7% after one year of sensor use, only 34.6% in the MDI group achieved these values. However, the CSII group presented a higher coefficient of variation (62.31% at 3 months and 43.08% at 1 year) (p = 0.02), and a higher number of hypoglycemic episodes (7.38% and 7.32%, respectively) (p = 0.016). The CSII group also had a higher number of capillary blood glucose measurements at the beginning of the study (8.32/day) (p = 0.249), but this number became similar between both groups after one year.

Conclusions: We found statistically significant differences in favor of CSII over MDI in terms of metabolic control after one year of isCGM use. However, the TIR values were still below the range considered to be indicative of good control. These findings lead us to question whether CSII should be initially considered in specific cases where HCL is not possible, or if it would be more effective to wait until the patient is ready, or the necessary resources are available to start directly CSII integrated in a closed loop system.