Diabetes technology & therapeutics | 2021
The SWEET project: 10-year benchmarking in 19 countries worldwide is associated with improved HbA1c and increased use of diabetes technology in youth with type 1 diabetes.
Abstract
OBJECTIVE\nThe international SWEET registry (NCT04427189) was initiated in 2008 to improve outcomes in paediatric diabetes. A 10-year follow up allowed studying time trends of key quality indicators in 22 centres from Europe, Australia, Canada and India in youth with type 1 diabetes (T1D).\n\n\nMETHODS\nAggregated data per person with T1D below 25 years of age were compared between 2008-2010 and 2016-2019. Hierarchic linear and logistic regression models were applied. Models were adjusted for gender, age- and diabetes duration-groups.\n\n\nRESULTS\nThe first and second time period included 4930 vs. 13654 persons, 51 vs. 52 % male, median age 11.3 [Q1;Q3: 7.9; 14.5] vs.13.3 [9.7; 16.4] years and T1D duration 2.9 [0.8; 6.4] vs. 4.2 [1.4;7.7] years. The adjusted HbA1C improved from 68 (95% CI: 66; 70) to 63 (60; 65) mmol/mol (p<0.0001). Across all age groups, HbA1c was significantly lower in pump and sensor users. Severe hypoglycaemia declined from 3.8 % (2.9; 5.0) to 2.4 % (1.9; 3.1) (p<0.0001), while DKA events increased significantly with injection therapy only. The cardiovascular risk factors BMI-SDS, diastolic blood pressure, total cholesterol also showed significant improvements. Over time, the increase in pump use from 34 to 44% preceded the increase in HbA1c target achievement (<53 mmol/mol) from 21 to 34%.\n\n\nCONCLUSIONS\nTwice yearly benchmarking within the SWEET registry was associated with significantly improved HbA1c and cardiovascular risk factors on a background of increasing pump and sensor use over 10 years in young persons with T1D.