1157-P: Diabetic Ketoacidosis (DKA) Rates Do Not Differ by Insulin Pump Use vs. Nonuse in Teens with Type 1 Diabetes (T1D) and Executive Function (EF) Problems

Abstract

Aim: Providers may resist offering pump therapy to teens with T1D who have challenges with EF (planning, organization) due to concerns for DKA. We evaluated rates of DKA and severe hypoglycemia according to pump use in teens with and without EF problems. Methods: Parents of teens aged 13-17 years with T1D provided proxy reports of teen EF using the Behavior Rating Inventory of Executive Function (BRIEF). Global Executive Composite (GEC) t-score ≥60 defined risk of executive dysfunction. Families reported severe hypoglycemic episodes and ER visits/hospitalizations for hyperglycemia (including DKA) every 3 months for 18 months. Incidence rates (IR) were calculated as events/100 person-years. DKA IR includes ER visits/hospitalizations for either hyperglycemia or DKA. Poisson regressions evaluated differences in IR by pump use, CGM use, and BRIEF score. Results: 169 teens (54% male) had baseline age 14.9±1.3 years, T1D duration 7.4±3.7 years, A1c 8.5±1.0%; 69% were pump users, 41% used CGM some time during follow-up, and 31% had GEC ≥60. During 297 person-years, severe hypoglycemia IR was 38.3/100 person-years and DKA IR was 7.7/100 person-years. There were no differences in hypoglycemia IR by pump or CGM use or GEC score. There was no difference in DKA IR by CGM use while DKA IR was lower in pump users vs non-users (4.9 vs 14.0, p=.01) and in those with GEC <60 vs ≥60 (4.9 vs 14.0, p=.01). Among those with GEC <60, DKA IR was lower in pump users vs non-users (2.0 vs 13.7, p=.003); in those with GEC ≥60, DKA IR was similar in pump users and non-users (13.7 vs 14.4, p=.94). Conclusion: In this sample of teens with T1D, hypoglycemia IR did not differ by pump or CGM use or EF status; in the teens with EF challenges, DKA IR was not higher in pump users vs non-users. These observations suggest that hesitation by clinicians to offer insulin pump therapy to teens with clinical suspicion of executive dysfunction due to concerns for increased DKA risk may not be warranted. Disclosure R.J.Vitale: None. L.K.Volkening: None. L.M.Laffel: Advisory Panel; Medtronic, Lilly Diabetes, Novo Nordisk, Vertex Pharmaceuticals Incorporated, Roche Diagnostics, Provention Bio, Inc., Consultant; Dexcom, Inc., Janssen Pharmaceuticals, Inc., Medscape. Funding National Institutes of Health (P30DK036836, R01DK095273); JDRF (2-SRA-2014-253-M-B); Iacocca Family Foundation