INTRODUCTION: The aim of the study was to assess the differences in key parameters of type 1 diabetes (T1D) control associated with treatment and monitoring modalities including newly introduced hybrid closed-loop (HCL) algorithm in children and adolescents with T1D (CwD) using the data from the population-wide pediatric diabetes registry ČENDA. METHODS: CwD younger than 19 years with T1D duration >1 year were included and divided according to the treatment modality and type of CGM used: multiple daily injection (MDI), insulin pump without (CSII) and with HCL function, intermittently scanned continuous glucose monitoring (isCGM), real-time CGM (rtCGM), and intermittent or no CGM (noCGM). HbA1c, times in glycemic ranges, and glucose risk index (GRI) were compared between the groups. RESULTS: Data of a total of 3,251 children (mean age 13.4 ± 3.8 years) were analyzed. 2,187 (67.3%) were treated with MDI, 1,064 (32.7%) with insulin pump, 585/1,064 (55%) with HCL. The HCL users achieved the highest median TIR 75.4% (IQR 6.3) and lowest GRI 29.1 (7.8), both p < 0.001 compared to other groups, followed by MDI rtCGM and CSII groups with TIR 68.8% (IQR 9.0) and 69.0% (7.5), GRI 38.8 (12.5) and 40.1 (8.5), respectively (nonsignificant to each other). These three groups did not significantly differ in their HbA1c medians (51.8 [IQR 4.5], 50.7 [4.5], and 52.7 [5.7] mmol/mol, respectively). NoCGM groups had the highest HbA1c and GRI and lowest TIR regardless of the treatment modality. CONCLUSION: This population-based study shows that the HCL technology is superior to other treatment modalities in CGM-derived parameters and should be considered as a treatment of choice in all CwD fulfilling the indication criteria.

1st Faculty of Medicine Prague Czechia

Department of Pediatrics 3rd Faculty of Medicine Prague Czechia

Department of Pediatrics Hospital České Budějovice České Budějovice Czechia

Department of Pediatrics Masaryk Hospital Ústí nad Labem Czechia

Department of Pediatrics Motol University Hospital and 2nd Faculty of Medicine Prague Czechia

Department of Pediatrics University Hospital Brno Brno Czechia

Department of Pediatrics University Hospital Hradec Králové Hradec Králové Czechia

Department of Pediatrics University Hospital Olomouc Olomouc Czechia

Department of Pediatrics University Hospital Ostrava Ostrava Czechia

Department of Pediatrics University Hospital Pilsen Pilsen Czechia

Department of Probability and Mathematical Statistics Faculty of Mathematics and Physics Charles University Prague Czechia

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Are all HCL systems the same? long term outcomes of three HCL systems in children with type 1 diabetes: real-life registry-based study