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.研究目的：尽管糖尿病管理水平已有所提升，但诸多1型糖尿病（type 1 diabetes, T1D）青少年患者，尤其是伴随进食障碍行为（disordered eating behaviors, DEB）的群体，仍难以达成血糖控制目标，且糖化血红蛋白（HbA1c）水平更高。本研究旨在评估启用胰岛素泵治疗后，1型糖尿病青少年患者的糖化血红蛋白水平与进食障碍行为的变化趋势。 研究方法：本研究为前瞻性纵向研究，随访周期为12个月，共纳入38名年龄在10至20岁之间的1型糖尿病青少年患者。分别于基线（胰岛素泵启用前）、启用后2个月、6个月及12个月时对受试者进行评估。研究数据采集自病历记录与自我报告问卷。 研究结果：糖化血红蛋白水平与进食障碍行为随时间推移未出现显著变化。然而，存在进食障碍行为的青少年患者，其糖化血红蛋白水平始终高于无进食障碍行为者（P=0.003）。存在身体不满情绪的青少年，尤其是渴望拥有更苗条身材者，其糖化血红蛋白与进食障碍行为水平均显著升高（分别对应P=0.012与P<0.001）。糖化血红蛋白的变化趋势因胰岛素给药方式不同而存在显著差异（P=0.005），其中使用混合闭环（hybrid closed-loop, HCL）系统的患者，糖化血红蛋白水平降幅最大（P=0.04）。 研究结论：尽管启用了胰岛素泵治疗，本研究周期内全体受试者的糖化血红蛋白与进食障碍行为水平未出现显著的整体变化。但使用混合闭环系统的青少年患者糖化血红蛋白水平有所降低，而存在进食障碍行为的患者相关指标仍维持在较高水平。存在身体不满情绪的青少年，尤其是渴望拥有更苗条身材者，其糖化血红蛋白与进食障碍行为水平均更高。本研究结果提示，在糖尿病治疗技术的应用过程中，需为该高风险群体提供针对性支持。未来需开展更大样本量的研究，以指导针对这一群体的有效干预方案制定。