Hybrid Therapy in Youth with Type 1 Diabetes - Continuous Subcutaneous Insulin Infusion (CSII) Combined with Long-Acting Insulin: a Real-Life Experience

Galia Barash ^1,2 Liat Lerman ^2,3 Tal Ben-Ari ^2,4 Shirli Abiri ^2,4 Zohar Landau ^5,6 Michal Ben Ami ^2,7 Avivit Brener ^2,8 Yael Lebenthal ^2,8 Orit Pinhas-Hamiel ^2,5,7 Kineret Mazor-Aronovitch ^2,5,7 Alon Haim ^6,9 Jonathan Yeshayahu ^6,10 Liat de Vries ^2,3 מריאנה רחמיאל ^1,2

¹Pediatric Endocrinology and Diabetes Institute, Shamir (Assaf Harofeh) Medical Center,, ישראל
²Sackler Faculty of Medicine, Tel Aviv University, ישראל
³The Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, ישראל
⁴Pediatric Endocrine and Diabetes Unit, Edith Wolfson Medical Center, ישראל
⁵National Juvenile Diabetes Center, Maccabi Health Care Services, ישראל
⁶Faculty of Health Sciences, Ben-Gurion University of the Negev, ישראל
⁷The Edmond and Lily Safra Children’s Hospital, Chaim Sheba Medical Center,, Pediatric Endocrine and Diabetes Unit, ישראל
⁸Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, ישראל
⁹Pediatric Endocrine and Diabetes Unit, , Soroka Medical School,, ישראל
¹⁰Pediatric Endocrine and Diabetes Unit, Assuta Medical Center, ישראל

Background: The utilization of CSII in type 1 diabetes (T1D) is associated with increased risk of diabetic ketoacidosis (DKA). The rationale behind using hybrid modality, long-acting insulin for basal coverage and CSII for boluses, is the prevention of insulin delivery failure and subsequent hyperglycemia and DKA.

Aims: To explore the hybrid treatment modality in clinical practice in youth with T1D.

Methods: Multicenter, observational study of youth with T1D who initiated hybrid modality between 2013 and 2020. Extracted from the medical records were data on sociodemographic characteristics, reason for hybrid treatment initiation, glycemic metrics of 2 weeks, HbA1c and frequency of DKA episodes, collected at initiation (last 6 months), after 6 months, and at last visit.

Results: Fifty-five patients (52.7% males) were treated with hybrid therapy, median age at initiation 14.5 [IQR 12.4, 17.3] years, HbA1c 9.2 [IQR 8.2, 10.2], mean glucose levels 221 mg/dL [IQR 181, 226] and treatment duration 18 [IQR 12, 47] months. Hybrid treatment was initiated due to fear of sustained hyperglycemia in 41.8%, DKA episodes in 30.8%, refusal to use CSII continuously in 14.6%. HbA1c did not change significantly throughout follow-up (P=0.262). Mean glucose levels decreased after 6 months (P= 0.034), and remained stable thereafter (P=0.274,p=0.641). Frequency of DKA decreased after 6 months (4 events/4 patients), and at end of follow up (10/10), compared with baseline (24/14) (P=0.002, P=0.031).

Conclusions: Our findings suggest that this hybrid therapy is a feasible option in the management of youth with T1D, which may reduce the risk of DKA episodes.