Clinical and quality of life outcomes in children and adolescents with type 1 diabetes using different insulin therapy types: a cross-sectional observational study

Background: Type 1 diabetes (T1D) requires lifelong insulin therapy. Although multiple daily injections (MDI) remain widely used, advanced technologies, such as continuous subcutaneous insulin infusion (CSII) and automated insulin delivery (AID) system have demonstrated benefits in glycemic control and quality of life (QoL). However, comparative data on these modalities in pediatric population are still limited. This study examined the associations between therapy type, clinical outcomes, and health-related QoL (HRQoL) in children and adolescents with T1D. Methods: Demographic, anthropometric, and clinical data were collected from 262 children and adolescents with T1D. HRQoL was assessed using the Pediatric Quality of Life Inventory (PedsQL) 3.2 Diabetes Module. Results: Among participants, 62% were treated with MDI, 11% with CSII, and 27% with AID, without significant differences between children and adolescents. In adolescents, MDI users showed significantly higher mean HbA1c values and suboptimal glycemic control (p-value < 0.001), higher daily insulin requirements (p-value = 0.003), and lower estimated glomerular filtration rate (eGFR) (p-value < 0.001) compared with CSII and AID users. While, in children only eGFR was associated with therapy type (p-value < 0.001). Only female adolescents reported better QoL when treated with CSII, with therapy type associated with HRQoL domains related to Worry (p-value = 0.031), Management (p-value = 0.050), and total HRQoL (p-value = 0.034). Overall, adolescent females also showed poorer HRQoL than males, particularly in domains related to worry about diabetes complications (p-value  =0.002), and communication difficulties (p-value < 0.001). Conclusions: The use of modern insulin delivery technologies was associated with improved clinical outcomes, including early renal markers. However, HRQoL were limited and predominantly observed in female adolescents, who nevertheless reported lower overall QoL than their male peers. These findings suggest that while technological advances can enhance clinical outcomes, they may not fully address the psychosocial challenges of living with T1D, especially during female adolescence, a period of heightened emotional vulnerability. Integrating gender- and age-sensitive psychosocial support alongside technological innovations may be crucial to achieving holistic diabetes care.