EP525 - ECE_2601 - Real-world glycemic outcomes in pediatric type 1 diabetes after automated insulin delivery initiation

Abstract

Automated insulin delivery (AID) systems are increasingly used in the management of type 1 diabetes mellitus (T1DM) and are fully funded for eligible patients in Portugal. We aimed to assess longitudinal changes in glycemic control following AID initiation in a pediatric T1DM cohort. Retrospective longitudinal study of children and adolescents with T1DM using AID for at least 3 months. Data were collected at baseline and during follow-up (median follow-up: 11.8 months; range 3.0-52.4). International consensus targets were evaluated: HbA1c <6.5% for advanced technology users (ISPAD 2024), Time In Range (TIR 70-180 mg/dL) ≥70% and Time Below Range (TBR <70 mg/dL <4%) when available. Of 200 patients assessed, 157 were included (51.6% female; median age at diagnosis: 5.78 years). Median HbA1c decreased significantly from 7.5% at baseline to 6.8% at 3 months (P < .001) and remained stable at 12 months (median 6.7%; paired n = 26). Regarding the stringent ≤ 6.5% target, attainment increased nearly fourfold, from 12.1% (19/157) at baseline to 42.3% (11/26) at 12 months. The proportion of patients achieving the standard HbA1c < 7.0% goal rose from 27.4% to 84.6% at one year. Regarding CGM metrics, median TIR increased from 60% to 70% at 12 months (P < .001), with 51.7% of participants achieving the ≥ 70% target. Low exposure to hypoglycemia was maintained, with Time Below Range remaining <4% throughout follow-up. Safety was further demonstrated by the low incidence of acute complications: 3 episodes of moderate diabetic ketoacidosis and one episode of severe hypoglycemia (with loss of consciousness) were recorded during the observation period. In this real-world pediatric T1DM cohort, AID initiation was associated with rapid and sustained improvements in glycemic control. Notably, the use of these systems allowed a substantial proportion of patients to reach the optimized HbA1c ≤ 6.5% goal without increasing hypoglycemia, supporting the effectiveness of AID in achieving the most recent clinical targets in pediatric T1DM.