Automated insulin delivery in war refugee children with type 1 diabetes: a 3-year follow-up

Vít Neuman, Lukáš Plachý, Stepanka Pruhova, Stanislava Koloušková, Barbora Obermannová, L. Drnkova, Shenali Anne Amaratunga, Petra Konečná, J. Vyzralkova, Petra Venháčová, Renata Pomahačová, Petra Paterová, Lucie Stichova, Jaroslav Škvor, Kamila Kocourková, Martina Romanová, Jan Vosáhlo, Jiří Strnadel, Kristina Poločková, Jan Knížek, David Neumann, Matvei Slavenko, Markéta Pavlı́ková, Zdenĕk Šumnı́k

Objective Following the war in Ukraine, Europe received a large influx of war refugees, including children with type 1 diabetes (CwD). The aim of this study was to describe their diabetes control during the first three years. Research design and methods A total of 143 (70 M, 73 F) CwD were recruited into this longitudinal observational study between March 2022 and June 2025 at 9 tertiary pediatric diabetes centers. The following data were collected yearly: treatment type, CGM use, anthropometrics, HbA1c, and CGM metrics. Statistical inference was performed using linear mixed models adjusting for age, sex, age at T1D onset, and therapy type. Additionally, the participants were compared to matched controls from a nationwide pediatric diabetes registry. Results The median HbA1c decreased significantly from 58.0 mmol/mol, 7.5% (IQR 49.0-73.0, 6.6–8.8%) to 52 mmol/mol, 6.9% (IQR 48–64 mmol/mol, 6.5–8.0%) over 3 years (P<0.001). We observed a significant increase in CGM use (46.4% to 95.5%) and insulin pump use, from 8.0% (no AID systems) to 63.6% (only AID systems) (both P<0.001). The trend in HbA1c decline depended on the therapy type, the estimated effect of AID initiation was −5.39 mmol/mol (95% CI −10.12 to −0.65 mmol/mol) (P = 0.003). The mean time in range (TIR) of CwD who initiated AID was not significantly different from that of matched non-migrant controls (73.4% vs. 71.0%, P = 0.420), while those using insulin pens had a lower TIR than controls (51.8% vs. 62.9%, P = 0.003). Conclusions We observed a significant improvement in T1D control among refugee CwD, emphasizing the role of AID, regardless of socioeconomic background.