ESPE Yearbook of Paediatric Endocrinology

Brief Summary: This observational study highlights the challenges of managing T1D in 8,004 young children with type 1 diabetes (T1D) (age < 6 years) from 3 international registries: Diabetes Prospective Follow-Up Registry (DPV), T1D Exchange Quality Improvement Network (T1DX-QI), and the Australasian Diabetes Data Network (ADDN), using data collected between 2019 and 2021. More than half of included children did not achieve the recommended HbA1c target < 7.0% (53 mmol/mol). While continuous glucose monitoring (CGM) was used by most participants, insulin pump use varied between the registries and hybrid closed loop (HCL) use was rare.

These data are alarming given the known association between suboptimal glycemic levels and the risk of acute and chronic complications (1). Furthermore, the study underscores disparities in the use of diabetes technologies, such as CGM and insulin pumps and particularly HCL systems, with lower use among children from low socioeconomic backgrounds. Despite strong evidence supporting the value of HCL systems in this young population (2,3), their use was uncommon across all three registries. This is most likely due to pending regulatory approvals in very young children during the study period (2019-2021). Use of HCL systems in this age group is progressively increasing and should lead to more young children achieving optimal glycemic targets. However, advocacy is essential to improve access to diabetes technologies for all young children with T1D in a timely and equitable manner.

In line with the increasing number of overweight/obese children in the general population, the study reported that a high percentage of T1D children had a BMI in the overweight range (36-50%), which may explain some of the variation in outcomes between the registries.

Although this study comprises a large sample size, all 3 registries cover primarily high-income countries and do not reflect the situation in middle- and low-income countries.

In conclusion, these findings underscores the complexity of managing T1D in young children and the need for personalized care and equitable access to advanced technologies.

References: 1. de Bock M, Codner E, Craig ME, et al. ISPAD Clinical Practice Consensus Guidelines 2022: Glycemic targets and glucose monitoring for children, adolescents, and young people with diabetes. Pediatr Diabetes. 2022;23(8):1270-1276.2. Ware J, Allen JM, Boughton CK, et al.; KidsAP Consortium. Randomized trial of closed-loop control in very young children with type 1 diabetes. N Engl J Med 2022;386:209–219.3. Wadwa RP, Reed ZW, Buckingham BA, et al.; PEDAP Trial Study Group. Trial of hybrid closed-loop control in young children with type 1 diabetes. N Engl J Med 2023;388:991–1001.