To Örebro University

Introduction: In 2017 Sweden lowered the national HbA1c target for children with T1D to 48mmol/mol (6.5%), corresponding to an average glucose of 8mmol/L (144mg/dL).

The target was communicated to pediatric diabetes clinics andto families. Sweden has a population based National Diabetes Register where data on a group level from all the 42 pediatric clinics treating children with T1D are openly published.

Objectives: To investigate the time trend in Time in Tight Range (TITR) and change in CGM as well as in pump use and the proportion of overweight since 2017.

Methods: Population based data were retrieved from NDR. Significance levels were calculated using chi2 test and p <0.01 was considered significant.

Results: 99% (7630/7700) of the children were using a CGM device in 2023, compared with 91.5% (6620/7230) in 2017 and 96% (6890/7190) in 2019. During the same period, the proportion of pump users has increased from 63.5% (4575/7200) in 2017 to 69% (5000/7220) in 2019 and to 82% (6460/7880) in 2023. 48% of these children reached 50% or more TITR in 2023 compared to 30.5% in 2018 and 36% in 2019, p<0.01 (Fig 1a). During the same period the proportion of overweight including obesity is unchanged (Fig 1b).

Conclusions: The percentage of children reaching ≥ 50% TITR has increased by 60% since the national HbA1c target in Sweden was lowered to 48 mmol/mol and by 35% since 2019. Lowering the national HbA1c target, as well as an increased access to modern technology, that facilitates the possibility to reach TITR, are likely factors in achieving these improvements. A glucose control close to normal as well as preventing overweight are important factors to decrease the risk of long-term complications due to T1D.