Sensor-Augmented Pump Therapy: description of pediatric patients with Type 1 Diabetes Mellitus (T1D) and initial metabolic outcomes

Abstract

The insulin microinfuser with integrated system (SAPT) for patients with type 1 Diabetes Mellitus (T1D) is included in the national financial protection system for high-cost treatments. 

Objective: To describe the initial and first-year metabolic outcomes and epidemiological and nutritional characteristics of T1D pediatric patients treated with SAPT. 

Patients and Method: Retrospective, descriptive and analytical study of clinical records from 2017 to 2019, of 12 patients with T1D users of SAPT, attended in a referral hospital. Variables: age at program entry, time of evolution of the disease, type of insulin treatment and type of glucose monitoring (capillary: sample or Continuous Glucose Monitoring [CGM]) at program entry, cause of application to the program, nutritional status, rural or urban origin, educational level of the main guardian, HbA1c at application and in the last month of each quarter after SAPT installation, over a 12-month period. HbA1c analysis was venous sample by High-Performance Liquid Chromatography and follow-up was capillary sample by Latex Particle Agglutination Inhibition. 

Results: The median variables at 12 months of treatment were Total Daily Dose (TDD) 0.74, %Basal (%B) 49%, Time In Range (TIR) 39%, Time Below Range (TBR) 1%, and HbA1c 7.7%. The sensor usage time was met in all cases and only half of them achieved a correct execution of hyperglycemia and hypoglycemia treatment. Inadvertent severe hypoglycemia was the main cause of application to the program. 

Conclusion: TDD and %B increased, approaching physiological requirement, although without statistical significance, which could be attributed to the administration of adequate insulin with lower risk of hypoglycemia due to predictive suspension and CGM. TIR presented a favorable increase, although not significant, nor reaching the target range, attributable to the short observation time, difficulties in understanding and execution of our patients, and the learning process of the treating clinical team. SAPT was effective in hypoglycemia management and effective in improving HbA1c.