Zimmerman, A, Lanzinger, S, Skrivarhaug, T, Svensson, J, Craig, M, Rompicherla, S, Maahs, D, Ebekozien, O, Neuman, V, Cinek, O, Ranjan, A, Holl, R, Robinson, H, Warner, J, Akesson, K, Witsch, M, Lund-Blix, N, Bratke, H, Sumnik, Z, Kummernes, S, Johnson, S, Madsen, M, Eeg-Olofsson, K, Pons Perez, S, Alonso, G, Thoren, A

Advances in pediatric type 1 diabetes (T1D) management in the last 10 years have led to improvements in glycemic control. Our objective was to compare T1D treatment regimen and glycemic outcomes over a 10-year period, from 8 diabetes registries and the SWEET initiative.

Registries included ADDN, ČENDA, DanDiabKids, DPV, NCDR, NPDA, Swediabkids, T1DX-QI and SWEET. Investigators compared data from 2013 to 2022. Children aged <u><</u>18 years with T1D duration ≥ 3 months were included. For each registry, demographics, HbA1c data, insulin regimen, diabetes ketoacidosis (DKA) and severe hypoglycemia rates were collected. Join point regression analysis was used to study significant breakpoints in temporal trends.

Data were available for 109,494 children from the national registries and 35,590 from SWEET. Mean age between registries was similar and stable over time. Mean HbA1c decreased on average from 66.4 mmol/mol in 2013 to 59.3 mmol/mol in 2022, improving in all registries (Fig. 1). Insulin pump use varied widely but increased in all registries (on average 42.9% 2013 to 62.2% in 2022) (Fig. 1). A decreasing trend of DKA and severe hypoglycemia was observed in most registries over time.

Glycemic control improved in children with T1D in all registries over the last 10 years. Use of technology has increased dramatically over this time although with significant differences between registries.

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