Automated Insulin Delivery improves care for children with Type 1 Diabetes
October 9, 2024
Source: Boucsein, A et al N Engl J Med Evidence, October, 2024. Optimal HbA1C is 7 or less, and optimal blood sugar is under 140.
The human pancreas carefully regulates blood glucose (sugar) levels, and those with diabetes need to constantly monitor their blood glucose and adjust their insulin dose to keep their blood sugar in a healthy range. Recently, people with diabetes have been able to automate insulin delivery by using a combination of a continuous glucose monitor and an algorithm that instructs a connected pump to deliver just the right dose of insulin to keep blood glucose under good control. This is especially helpful for young people with Type 1 diabetes and decreases their need to draw blood from their fingers and administer insulin injections.
Researchers published a report in New England Journal Evidence demonstrating just how much better the diabetes control was for patients between ages 7 and 25. As you see above, HbA1C results and average blood sugar readings were vastly improved. Those with automated insulin delivery on average had eight hours more each day of their blood sugar in the target range. Better blood sugar control is associated with lower future risk of cardiovascular disease, kidney disease, eye disease, disability and death.
This was a randomized trial, although the size is relatively small (80 patients, 37 of whom got the intervention. The control group had three serious diabetes-related complications (two cases of ketoacidosis where blood sugar was too high, and one case of hypoglycemia where the blood sugar was too low). There were no severe adverse outcomes in the intervention group.
Implications for employers:
- Employers should evaluate their health plans to be sure that members can afford this type of care for children who have Type 1 diabetes. Most plans cover continuous glucose monitors, and insurance plans increasingly cover insulin pumps. In general, the algorithm to control insulin delivery is bundled as part of the insulin pump.
- This technology can improve long term health of those with Type 1 diabetes; it may also decrease hospitalizations to the extent there are fewer episodes of exceptionally high or low blood sugars.
This technology can also decrease time away from work for parents of children with diabetes.