Integrated real-time continuous glucose monitoring/ insulin pump system (PRT) usefulness in 122 children with type 1 diabetes. A 3-year follow-up study

Objectives: Real-time continuous glucose monitoring and the insulin pump have been combined into the sensor-augmented pump system (PRT) (Medtronic MiniMed, Sesto San Giovanni, Italy). The objective of the study was to evaluate the clinical effectiveness and safety of PRT in a large series of children with type 1 diabetes using insulin pump therapy. Methods: This is a multicenter observational study. A questionnaire was sent to all paediatric diabetologic centres in Italy (n=65); data was analyzed only regarding patients aged 18 or less and using PRT for 6 months or more. Results: A total of 48 centres (73.85%) answered the questionnaire. The total number of patients with type 1 diabetes followed by the centres is 12.549, of whom 1437 (11.4%) have been using insulin pump therapy for more than 6 months. Of all patients using an insulin pump, 129 have been using PRT for at least 6 months, with a mean follow-up of 1.4 ± 0.7 yrs (range 0.5-3 yrs). Their age was 13.5 ± 3.8 yrs, with disease duration of: 6.3 ± 3.4 yrs). After 0.5-3 yrs of using PRT, HbA1c showed a significant improvement (8 ± 1.5 versus 7.4 ± 0.8%, P = 0.002). Insulin requirement showed a significant decrease (0.88 ± 0.25 versus 0.79 ± 0.23 U/kg/day, P = 0.003). BMI did not change during the observational period. Mean usage of PRT per month was 8.1 day/month and any significant correlation between sensor use and HbA1c has been observed (r2 = 0.0005, P = 0.239). No DKA was observed during the follow-up, while episodes of severe hypoglycemia significantly decreased (P = 0.04). Conclusion: The increased availability of continuous glucose sensors is likely to have a significant impact on pediatric diabetes therapy and education in the near future. Selection of patients capable and motivated to use sensor-augmented pump with proper age-appropriate education could be the key factors for the long-term success of these new technological advances in diabetes therapy as we have seen in our large group of children using PRT.