Hybrid Insulin Management using Pump Combined with Long-acting Insulin in Youth with Type 1 Diabetes - May Be a Lifesaver: National Real-life Experience
2Sackler Faculty of Medicine, Tel Aviv University
3The Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel
4Pediatric Endocrine and Diabetes Unit, Edith Wolfson Medical Center
5National Juvenile Diabetes Center, Maccabi Health Care Services
6Faculty of Health Sciences, Ben-Gurion University of the Negev
7Pediatric Endocrine and Diabetes Unit, The Edmond and Lily Safra Children’s Hospital, Chaim Sheba Medical Center
8Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center
9Pediatric Endocrine and Diabetes Unit, Soroka Medical Center
10Pediatric Endocrine and Diabetes Unit, Assuta Medical Center
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 and CSII, 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. Data was extracted from the medical records at initiation of the hybris therapy, 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). Mean Ffrequency of DKA per month per patient decreased after 6 months from 0.073 (min 0,max 0.5) to 0.020 (min0, max 0.5), p=0.011, and at end of follow up to 0.016 min 0,max 0.25), p=0.007. (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.
