Temporal Trends for Diabetes Management and Glycemic Control Between 2010 and 2019 in Korean Children and Adolescents with Type 1 Diabetes
Jaewon Choe, Seung Won, Yunsoo Choe, Sang Hee Park, Yun Jeong Lee, Ji Eun Lee, Young Ah Lee, Han Hyuk Lim, Jae Ho Yoo, Seong Yong Lee, Eun Young Kim, Choong Ho Shin, Jae Hyun Kim
Abstract
Purpose: There is increasing use of modern devices in the management of patients with type 1 diabetes (T1D). We investigated temporal trends for diabetes management and outcomes in Korean pediatric T1D patients over 10 years. Methods: We retrospectively collected the data from 752 participants (boys: 311, 41.4%) diagnosed with T1D and aged ≤18 years, with ≥1 year of follow-up between 2010 and 2019 in any of the seven study hospitals in Korea. Results: Over the 10-year study period, use of continuous glucose monitoring (CGM) increased from 1.4% to 39.3%. From 2010 to 2019, there was an increased use of multiple daily insulin injections (MDI; 63.9%–77.0%, respectively) and continuous subcutaneous insulin infusion (CSII; 2.1%–14.0%, respectively), but decreased use of conventional insulin therapy (CIT, 33.9%–9.0%, respectively). Mean glycated hemoglobin (HbA1c) decreased from 8.56% to 8.01% ( P < 0.001) and was lower in younger patients, boys, and CGM users ( P < 0.001). MDI and CSII users had lower mean HbA1c levels than CIT users ( P = 0.003). Regarding the acute complications of T1D, CGM use was associated with lower incidences of diabetic ketoacidosis ( P = 0.015); CSII users were likely to experience less severe hypoglycemia ( P = 0.008). Conclusions: The use of CSII and CGM increased ∼7- and 30-fold, respectively, over the 10-year study period. The glycemic control of pediatric T1D patients in Korea improved from 2010 to 2019, probably because of increased use of T1D technologies.