Background

Advances in paediatric type 1 diabetes management and increased use of diabetes technology have led to improvements in glycaemia, reduced risk of severe hypoglycaemia, and improved quality of life. Since 1993, progressively lower HbA_1c targets have been set. The aim of this study was to perform a longitudinal analysis of HbA_1c, treatment regimens, and acute complications between 2013 and 2022 using data from eight national and one international paediatric diabetes registries.

Methods

In this longitudinal analysis, we obtained data from the Australasian Diabetes Data Network, Czech National Childhood Diabetes Register, Danish Registry of Childhood and Adolescent Diabetes, Diabetes Prospective Follow-up Registry, Norwegian Childhood Diabetes Registry, England and Wales' National Paediatric Diabetes Audit, Swedish Childhood Diabetes Registry, T1D Exchange Quality Improvement Collaborative, and the SWEET initiative. All children (aged ≤18 years) with type 1 diabetes with a duration of longer than 3 months were included. Investigators compared data from 2013 to 2022; analyses performed on data were pre-defined and conducted separately by each respective registry. Data on demographics, HbA_1c, treatment regimen, and event rates of diabetic ketoacidosis and severe hypoglycaemia were collected. ANOVA was performed to compare means between registries and years. Joinpoint regression analysis was used to study significant breakpoints in temporal trends.

Findings

In 2022, data were available for 109 494 children from the national registries and 35 590 from SWEET. Between 2013 and 2022, the aggregated mean HbA_1c decreased from 8·2% (95% CI 8·1–8·3%; 66·5 mmol/mol [65·2–67·7]) to 7·6% (7·5–7·7; 59·4mmol/mol [58·2–60·5]), and the proportion of participants who had achieved HbA_1c targets of less than 7% (<53 mmol/mol) increased from 19·0% to 38·8% (p<0·0001). In 2013, the aggregate event rate of severe hypoglycaemia rate was 3·0 events per 100 person-years (95% CI 2·0–4·9) compared with 1·7 events per 100 person-years (1·0–2·7) in 2022. In 2013, the aggregate event rate of diabetic ketoacidosis was 3·1 events per 100 person-years (95% CI 2·0–4·8) compared with 2·2 events per 100 person-years (1·4–3·4) in 2022. The proportion of participants with insulin pump use increased from 42·9% (95% CI 40·4–45·5) in 2013 to 60·2% (95% CI 57·9–62·6) in 2022 (mean difference 17·3% [13·8–20·7]; p<0·0001), and the proportion of participants using continuous glucose monitoring (CGM) increased from 18·7% (95% CI 9·5–28·0) in 2016 to 81·7% (73·0–90·4) in 2022 (mean difference 63·0% [50·3–75·7]; p<0·0001).

Interpretation

Between 2013 and 2022, glycaemic outcomes have improved, parallel to increased use of diabetes technology. Many children had HbA_1c higher than the International Society for Pediatric and Adolescent Diabetes (ISPAD) 2022 target. Reassuringly, despite targeting lower HbA_1c, severe hypoglycaemia event rates are decreasing. Even for children with type 1 diabetes who have access to specialised diabetes care and diabetes technology, further advances in diabetes management are required to assist with achieving ISPAD glycaemic targets.

Funding

None.

Translations

For the Norwegian, German, Czech, Danish and Swedish translations of the abstract see Supplementary Materials section.

中文翻译：

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超过 100 000 名 1 型糖尿病儿童的治疗方案和血糖结果 （2013-22）：儿科糖尿病登记处数据的纵向分析

 背景

儿科 1 型糖尿病管理的进步和糖尿病技术使用的增加导致血糖改善、严重低血糖风险降低和生活质量改善。自 1993 年以来，已设定逐渐降低 HbA_1c 的目标。本研究的目的是使用来自 8 个国家和 1 个国际儿科糖尿病登记处的数据，对 2013 年至 2022 年间的 HbA_1c、治疗方案和急性并发症进行纵向分析。

 方法

在这项纵向分析中，我们从澳大利亚糖尿病数据网络、捷克国家儿童糖尿病登记处、丹麦儿童和青少年糖尿病登记处、糖尿病前瞻性随访登记处、挪威儿童糖尿病登记处、英格兰和威尔士国家儿科糖尿病审计处、瑞典儿童糖尿病登记处、T1D Exchange 质量改进合作组织和 SWEET 倡议。纳入所有病程超过 3 个月的 1 型糖尿病儿童 （≤18 岁）。研究人员比较了 2013 年至 2022 年的数据;对数据进行的分析是预定义的，并由每个相应的注册处单独进行。收集了有关人口统计学、 HbA_1c 、治疗方案以及糖尿病酮症酸中毒和严重低血糖事件发生率的数据。进行方差分析以比较登记处和年份之间的平均值。连接点回归分析用于研究时间趋势中的重要断点。

 发现

2022 年，有 109 494 名儿童的数据来自国家登记处，35 590 名儿童来自 SWEET。2013 年至 2022 年期间，总平均 HbA_1c 从 8·2%（95% CI 8·1-8·3%;66·5 mmol/mol [65·2–67·7]）下降到 7·6%（7·5-7·7;59·4mmol/mol [58·2-60·5]），达到 HbA_1c 目标低于 7% （<53 mmol/mol） 的参与者比例从 19·0% 增加到 38·8% （p<0·0001）。2013 年，严重低血糖发生率的总事件率为每 100 人年 3·0 事件（95% CI 2·0-4·9），而 2022 年为每 100 人年 1·7 事件 （1·0-2·7）。2013 年，糖尿病酮症酸中毒的总事件率为每 100 人年 3·1 事件（95% CI 2·0-4·8），而 2022 年为每 100 人年 2·2 事件（1·4-3·4）。使用胰岛素泵的参与者比例从 2013 年的 42·9%（95% CI 40·4-45·5）增加到 2022 年的 60·2%（95% CI 57·9-62·6）（平均差 17·3% [13·8-20·7];p<0·0001），使用连续血糖监测 （CGM） 的参与者比例从 2016 年的 18·7%（95% CI 9·5-28·0）增加到 2022 年的 81·7%（73·0-90·4）（平均差63·0% [50·3–75·7];p<0·0001）。

 解释

2013 年至 2022 年期间，血糖结果有所改善，与糖尿病技术使用的增加平行。许多儿童的 HbA_1c 高于国际儿科和青少年糖尿病学会 （ISPAD） 2022 年的目标。令人欣慰的是，尽管目标值较低 HbA_1c，但严重低血糖事件发生率正在下降。即使对于能够获得专业糖尿病护理和糖尿病技术的 1 型糖尿病儿童，也需要进一步推进糖尿病管理，以帮助实现 ISPAD 血糖目标。

 资金

 没有。

 翻译

有关摘要的挪威语、德语、捷克语、丹麦语和瑞典语的翻译，请参见补充材料部分。