Continuous Glucose Monitoring and Automated Insulin Delivery in Infants with Type 1 Diabetes: Real-World Evidence to Support Future International Guidelines
Abstract
To evaluate efficacy and safety of continuous glucose monitoring (CGM) and automated insulin delivery (AID) in infants. A retrospective multicenter study (13 centers) of 76 children diagnosed with antibody-positive type 1 diabetes before age 2. Outcomes at 12 months were compared between AID users ( n = 47) and multiple daily injections (MDI)/SAP users ( n = 29). AID systems included Medtronic 780 G (38%), Tandem Control-IQ (38%), and CamAPS FX (24%). CGM median wear time was 97.0% (93.3; 98.1). AID users achieved significantly higher TIR (65% vs. 56%, P = 0.041) and time in tight range (TITR) (42% vs 32.5%, P = 0.038). In multivariable regression, AID was the sole independent predictor of lower HbA1c ( P = 0.035). Zero severe hypoglycemia (SH) events occurred in the AID group (vs. 7.1% in MDI/SAP). Use of CGM is safe in very young children, with AID systems proving superior to traditional therapy. This real-world evidence supports incorporating AID consideration into future international guidelines from the time of pediatric diagnosis.
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Authors: Marco Marigliano, Andrea Scaramuzza, Claudia Arnaldi, Riccardo Bonfanti, Valentino Cherubini, Roberto Franceschi, Fortunato Lombardo, Giulio Maltoni, Enza Mozzillo, Marta Bassi, Ivana Rabbone, Riccardo Schiaffini, Valentina Tiberi, Davide Tinti, Claudio Maffeis
Institutions: Azienda USL di Bologna, University of Verona, University of Naples Federico II, Università degli Studi del Piemonte Orientale “Amedeo Avogadro”, Azienda Ospedaliera Ospedale Maggiore, Istituti Ospitalieri di Cremona, Vita-Salute San Raffaele University, Azienda Ospedaliera Citta' della Salute e della Scienza di Torino, University of Genoa, Azienda Sanitaria Locale Viterbo, University of Trento, Istituto Giannina Gaslini, Diabetes Australia, Bambino Gesù Children's Hospital, University of Messina, Azienda Ospedaliera Universitaria Integrata Verona, Ospedali Riuniti Umberto I