Abstract: Disengagement from advanced technologies in pediatric type 1 diabetes: implications for glycemic control and DKA risk
D. Ferro1, D. Williams1, N. Karwal1, M. Rodrigues1, C. Mullaney2, L. Skrabonja2, B. Lockee1, E. Dewit1, J. Redel1, M. Clements1, R. McDonough1
1Children's Mercy Hospital, Endocrinology, Kansas City, USA, 2Cyft, Boston, USA
Introduction: The use of continuous glucose monitors (CGM), insulin pumps (PUMP) and hybrid closed loop systems has been associated with improved outcomes in pediatric type 1 diabetes (T1D) care.
Objectives: We sought to characterize near-term outcomes occurring after disengagement from diabetes devices.
Methods: We conducted a retrospective cohort study on youth, ages 0-21 years, in our diabetes clinics from 1/1/2018 through 12/1/2020. Using an IRB-approved data repository, we identified patients on a CGM or PUMP in two subsequent clinical encounters (E1 and E2, respectively). We defined four engagement categories. For each, we estimated the percent of DKA events and patients with an increase in glycated hemoglobin (A1c) of >0.3% between visits in the 180 days following E2.
Results: We identified a total of 519 patients that disengaged from pump or CGM. Compared to patients who are engaged with diabetes devices, we observed a higher DKA rate in patients that disengaged (5.3% vs 3.3 %, p=0.01). Furthermore, we identified four engagement categories that are shown in the table below
| Device | Category | E1 | E2 | Obs | N | A1c+STDEV | ∆A1c>0.3 | DKA |
| CGM | Non-engagement | No | No | 4537 | 1322 | 9.2 ± 1.9 | 38% | 8.2% |
| Disengagement | Yes | No | 969 | 810 | 8.5 ± 1.7 | 39% | 3.2% | |
| New engagement | No | Yes | 419 | 364 | 8.9 ± 1.7 | 32% | 3.6% | |
| Continued engagement | Yes | Yes | 3701 | 1073 | 8.0 ± 1.3 | 34% | 2.4% | |
| PUMP | Non-engagement | No | No | 3118 | 938 | 8.9 ± 2.0 | 40% | 7.5% |
| Disengagement | Yes | No | 385 | 373 | 8.3 ± 1.7 | 44% | 4.7% | |
| New engagement | No | Yes | 213 | 206 | 9.1 ± 2.0 | 36% | 8.5% | |
| Continued engagement | Yes | Yes | 3754 | 1184 | 8.5 ± 1.5 | 35% | 3.4% |
Conclusions: CGM and PUMP engagement support two of the seven pillars of diabetes self-management. This study highlights that disengagement from these devices associates with increased prevalence of rising A1c and DKA in the near term. Future studies identifying predictors of disengagement may offer novel intervention opportunities to forecast device disengagement and to develop interventions to prevent it.