Supplementary Material for: HbA1c and disordered eating behaviors trends in adolescents with type 1 diabetes following the implementation of insulin pump therapy

Aims: Despite improvement in diabetes management, many adolescents with type 1 diabetes (T1D), especially those with disordered eating behaviors (DEB), struggle to reach glycemic targets and have higher HbA1c levels. We aimed to evaluate HbA1c and DEB trends in adolescents with T1D following insulin pump implementation. Methods: This prospective longitudinal study, with 12 months follow-up, included adolescents (n=38) with T1D aged 10-20 years, who were assessed at baseline (prior to insulin pump implementation), and at 2-, 6-, and 12-months post-implementation. Data were collected from medical charts and self-reported questionnaires. Results: HbA1c and DEB levels showed no significant changes over time. However, adolescents with DEB consistently had higher HbA1c levels than those without (P = 0.003). Both HbA1c and DEB were elevated in adolescents with body dissatisfaction, particularly those desiring thinner bodies (P = 0.012 and P < 0.001, respectively). HbA1c trends varied by insulin delivery method (P = 0.005), with the greatest reduction observed in users of hybrid closed-loop (HCL) systems (P = 0.04). Conclusions: Despite insulin pump implementation, no significant overall changes were observed in HbA1c or DEB levels across the study period. However, adolescents using HCL systems showed reduced HbA1c, while levels remained elevated among those with DEB. Both HbA1c and DEB were higher in adolescents with body dissatisfaction, particularly those desiring thinner bodies. These findings highlight the need for targeted support during the adoption of diabetes technologies. Larger studies are warranted to guide effective interventions for this high-risk population.