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Lendínez-Jurado A, López-Siguero JP, Gómez-Perea A, Ariza-Jiménez AB, Becerra-Paz I, Tapia-Ceballos L, Cruces-Ponce C, Jiménez-Hinojosa JM, Morcillo S, Leiva-Gea I. Pediatric Type 1 Diabetes: Is Age at Onset a Determining Factor in Advanced Hybrid Closed-Loop Insulin Therapy? J Clin Med 2023; 12:6951. [PMID: 37959415 PMCID: PMC10647771 DOI: 10.3390/jcm12216951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/26/2023] [Accepted: 11/03/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND The integration of continuous glucose monitoring systems with insulin infusion pumps has shown improved glycemic control, with improvements in hyperglycemia, hypoglycemia, Hb1Ac, and greater autonomy in daily life. These have been most studied in adults and there are currently not many articles published in the pediatric population that establish their correlation with age of debut. METHODS Prospective, single-study. A total of 28 patients (mean age 12 ± 2.43 years, 57% male, duration of diabetes 7.84 ± 2.46 years) were included and divided into two groups according to age at T1D onset (≤4 years and >4 years). Follow-up for 3 months, with glucometric variables extracted at different cut-off points after the start of the closed-loop (baseline, 1 month, 3 months). RESULTS Significant improvement was evidenced at 1 month and 3 months after closed-loop system implantation, with better glycemic control in the older age group at baseline at TIR (74.06% ± 6.37% vs. 80.33% ± 7.49% at 1 month, p < 0.003; 71.87% ± 6.58% vs. 78.75% ± 5.94% at 3 months, p < 0.009), TAR1 (18.25% ± 4.54% vs. 14.33% ± 5.74% at 1 month, p < 0.006; 19.87% ± 5.15% vs. 14.67% ± 4. 36% at 3 months, p < 0.009) and TAR2 (4.75% ± 2.67% vs. 2.75% ± 1.96% at 1 month, p = 0.0307; 5.40% ± 2.85% vs. 3% ± 2.45% at 3 months, p < 0.027). CONCLUSIONS the use of automated systems such as the MiniMedTM780G system brings glucometric results closer to those recommended by consensus, especially in age at T1D onset >4 years. However, the management in pediatrics continues to be a challenge even after the implementation of these systems, especially in terms of hyperglycemia and glycemic variability.
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Affiliation(s)
- Alfonso Lendínez-Jurado
- Department of Pediatric Endocrinology, Hospital Regional Universitario de Málaga, 29011 Málaga, Spain; (J.P.L.-S.); (A.G.-P.); (I.B.-P.); (L.T.-C.); (C.C.-P.); (J.M.J.-H.); (I.L.-G.)
- Departamento de Farmacología y Pediatría, Universidad de Málaga, Andalucía Tech, Campus de Teatinos s/n, 29071 Málaga, Spain
| | - Juan Pedro López-Siguero
- Department of Pediatric Endocrinology, Hospital Regional Universitario de Málaga, 29011 Málaga, Spain; (J.P.L.-S.); (A.G.-P.); (I.B.-P.); (L.T.-C.); (C.C.-P.); (J.M.J.-H.); (I.L.-G.)
- Departamento de Farmacología y Pediatría, Universidad de Málaga, Andalucía Tech, Campus de Teatinos s/n, 29071 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain;
| | - Ana Gómez-Perea
- Department of Pediatric Endocrinology, Hospital Regional Universitario de Málaga, 29011 Málaga, Spain; (J.P.L.-S.); (A.G.-P.); (I.B.-P.); (L.T.-C.); (C.C.-P.); (J.M.J.-H.); (I.L.-G.)
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain;
| | - Ana B. Ariza-Jiménez
- Department of Pediatric Endocrinology, Hospital Universitario Reina Sofía, 14004 Córdoba, Spain;
- Department of Pediatrics, University of Cordoba, Av. Menéndez Pidal, 7, 14004 Córdoba, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14004 Córdoba, Spain
| | - Icía Becerra-Paz
- Department of Pediatric Endocrinology, Hospital Regional Universitario de Málaga, 29011 Málaga, Spain; (J.P.L.-S.); (A.G.-P.); (I.B.-P.); (L.T.-C.); (C.C.-P.); (J.M.J.-H.); (I.L.-G.)
| | - Leopoldo Tapia-Ceballos
- Department of Pediatric Endocrinology, Hospital Regional Universitario de Málaga, 29011 Málaga, Spain; (J.P.L.-S.); (A.G.-P.); (I.B.-P.); (L.T.-C.); (C.C.-P.); (J.M.J.-H.); (I.L.-G.)
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain;
| | - Carmen Cruces-Ponce
- Department of Pediatric Endocrinology, Hospital Regional Universitario de Málaga, 29011 Málaga, Spain; (J.P.L.-S.); (A.G.-P.); (I.B.-P.); (L.T.-C.); (C.C.-P.); (J.M.J.-H.); (I.L.-G.)
| | - José Manuel Jiménez-Hinojosa
- Department of Pediatric Endocrinology, Hospital Regional Universitario de Málaga, 29011 Málaga, Spain; (J.P.L.-S.); (A.G.-P.); (I.B.-P.); (L.T.-C.); (C.C.-P.); (J.M.J.-H.); (I.L.-G.)
| | - Sonsoles Morcillo
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain;
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain
- CIBER in Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III Madrid, 29010 Málaga, Spain
| | - Isabel Leiva-Gea
- Department of Pediatric Endocrinology, Hospital Regional Universitario de Málaga, 29011 Málaga, Spain; (J.P.L.-S.); (A.G.-P.); (I.B.-P.); (L.T.-C.); (C.C.-P.); (J.M.J.-H.); (I.L.-G.)
- Departamento de Farmacología y Pediatría, Universidad de Málaga, Andalucía Tech, Campus de Teatinos s/n, 29071 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain;
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Leiva-Gea I, Martos-Lirio MF, Gómez-Perea A, Ariza-Jiménez AB, Tapia-Ceballos L, Jiménez-Hinojosa JM, Lopez-Siguero JP. Metabolic Control of the FreeStyle Libre System in the Pediatric Population with Type 1 Diabetes Dependent on Sensor Adherence. J Clin Med 2022; 11:jcm11020286. [PMID: 35053981 PMCID: PMC8779594 DOI: 10.3390/jcm11020286] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 02/01/2023] Open
Abstract
Aims: To evaluate the relationship between daily sensor scan rates and changes in HbA1c and hypoglycemia in children. Methods: We enrolled 145 paediatric T1D patients into a prospective, interventional study of the impact of the FreeStyle Libre 1 system on measures of glycemic control. Results: HbA1c was higher at lower scan rates, and decreased as the scan rate increased to 15–20 scans, after which it rose at higher scan rates. An analysis of the change in hypoglycemia, based on the number of daily sensor scans, showed there was a significant correlation between daily scan rates and hypoglycemia. Subjects with higher daily scan rates reduced all levels of hypoglycaemia. Conclusions: HbA1c is higher at lower scan rates, and decreases as scan rate increases. Reductions in hypoglycemia were evident in subjects with higher daily scan rates.
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Affiliation(s)
- Isabel Leiva-Gea
- Pediatric Endocrinology, Hospital Regional Materno Infantil de Málaga, 29011 Malaga, Spain; (I.L.-G.); (M.F.M.-L.); (A.G.-P.); (L.T.-C.); (J.M.J.-H.); (J.P.L.-S.)
- Multidisciplinary Group on Paediatric Research, Instituto de Investigación Biomédica de Málaga, 29010 Malaga, Spain
- Pharmacology and Pediatrics Department, University of Malaga, 29016 Malaga, Spain
| | - Maria F. Martos-Lirio
- Pediatric Endocrinology, Hospital Regional Materno Infantil de Málaga, 29011 Malaga, Spain; (I.L.-G.); (M.F.M.-L.); (A.G.-P.); (L.T.-C.); (J.M.J.-H.); (J.P.L.-S.)
- Pharmacology and Pediatrics Department, University of Malaga, 29016 Malaga, Spain
| | - Ana Gómez-Perea
- Pediatric Endocrinology, Hospital Regional Materno Infantil de Málaga, 29011 Malaga, Spain; (I.L.-G.); (M.F.M.-L.); (A.G.-P.); (L.T.-C.); (J.M.J.-H.); (J.P.L.-S.)
| | - Ana-Belen Ariza-Jiménez
- Pediatric Endocrinology, Hospital Universitario Reina Sofia, 14004 Cordoba, Spain
- Correspondence:
| | - Leopoldo Tapia-Ceballos
- Pediatric Endocrinology, Hospital Regional Materno Infantil de Málaga, 29011 Malaga, Spain; (I.L.-G.); (M.F.M.-L.); (A.G.-P.); (L.T.-C.); (J.M.J.-H.); (J.P.L.-S.)
- Multidisciplinary Group on Paediatric Research, Instituto de Investigación Biomédica de Málaga, 29010 Malaga, Spain
| | - Jose Manuel Jiménez-Hinojosa
- Pediatric Endocrinology, Hospital Regional Materno Infantil de Málaga, 29011 Malaga, Spain; (I.L.-G.); (M.F.M.-L.); (A.G.-P.); (L.T.-C.); (J.M.J.-H.); (J.P.L.-S.)
| | - Juan Pedro Lopez-Siguero
- Pediatric Endocrinology, Hospital Regional Materno Infantil de Málaga, 29011 Malaga, Spain; (I.L.-G.); (M.F.M.-L.); (A.G.-P.); (L.T.-C.); (J.M.J.-H.); (J.P.L.-S.)
- Multidisciplinary Group on Paediatric Research, Instituto de Investigación Biomédica de Málaga, 29010 Malaga, Spain
- Pharmacology and Pediatrics Department, University of Malaga, 29016 Malaga, Spain
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