This study demonstrated that tailored diabetes education significantly enhances both adherence and glycemic control in children and adolescents with T1D initiating insulin pump therapy. The reduction in HbA1c and improvement in TIR observed in this cohort strongly support the integration of individualized training into clinical practice, especially when introducing advanced diabetes technologies such as CSII and CGM.
Educational intervention not only improved glycemic indices but also empowered patients and caregivers to manage insulin dosing, recognize and troubleshoot pump issues, and prevent complications. The improvement in diabetes knowledge scores at 3 and 6 months emphasizes the importance of ongoing reinforcement of educational content, particularly in pediatric populations where maturity and learning styles vary significantly.
Our findings are consistent with those of previous studies, highlighting the central role of education in optimizing outcomes with diabetes technology. For example, the ISPAD Clinical Practice Guidelines recommend individualized education as a cornerstone of pediatric T1D care. Moreover, real-world data from other regions have similarly shown that well-educated pump users achieve superior glycemic outcomes compared to those lacking structured instruction.
In agreement with the study conducted by Ozgen et al. [4]a total of 35 subjects participated in their prospective study. All patients were given insulin pump user retraining. Their knowledge level and application skills, metabolic parameters, quality of life, and satisfaction from treatment were evaluated at baseline and after 6 months. There was significant improvement in patients’ knowledge and application skills after insulin pump user retraining. HbA1c levels of patients with poor glycemic control improved after retraining (8.61% ± 0.78 vs. 8.23% ± 0.79, p = 0.02) [4].
The Current study agrees with another study conducted by Beato-Víbora et al. [5]who studied the effect of Implementation of an Advanced Hybrid Closed-Loop System in Adolescents and Adults with T1D on TIR. The study concluded that higher levels of diabetes education are associated with better glycemic control and improved overall management of the disease [5].
In the present study there was statistically significant improvement in ICR with P-value < 0.001 and ISF with P-value < 0.001 after shifting to insulin pump therapy among the studied patients. This was inconsistent with Karges et al. [6]which is a population-based cohort study comparing patients with T1D who used pump therapy and patients who used insulin injection therapy conducted in Germany; the study highlighted that total daily insulin dose was lower and prandial to total insulin ratio was higher in pump therapy compared with injection therapy, significant for all age groups of the matched cohort P < 0.001 [6].
The current study also highlighted some practical challenges, including device-related skin reactions and occasional technical errors. However, these were manageable and decreased over time with increased user experience and support.
In the present study there was a highly significant improvement of HbA1c after 6 months in patients on CSII either using flash glucose monitoring or SMBG especially among those who were well educated.
Improvements in CGM in recent years have changed the treatment of T1D by permitting the automation of glucose control [7].
In the current study, there was no significant difference between MiniMed 715 and MiniMed 780G pumps regarding hypoglycemia, hyperglycemia, cannula tenting, difficulties with carbohydrate counting, and set changes.
Moreover, there was significant improvement in TIR with P-value 0.048, 0.025 after 3 and 6 months respectively in well-educated patients. Agreeing with Alonso Martín et al. [8]who stated that an indication of good metabolic control in patients participating in the study was the absence of acute decompensation episodes with ketosis or severe hypoglycemia, as the result of adequate diabetes education, also improvement of patient’s technical skills after re-training program [8].
In Pacheco et al. [9] study, about 47 adults with T1D used a structured education program (SEP). The results showed that there was a significant reduction in glycated hemoglobin (HbA1c) levels by approximately 20% at one year and 11% at eight months after the program. Also, there was more than 70% improvement in TIR. This improvement in glycemic control was accompanied by increased knowledge about diabetes care and self-confidence in managing the disease [9].
Alassaf et al. [10]. conducted a retrospective study on a dietary structured education program for newly diagnosed children with T1D. They found that the program was associated with better glycemic control at six and twelve months after diagnosis. The program’s effectiveness was particularly evident in children older than five years and those with higher maternal educational levels [10].
Essien et al. [11].in a randomized control study, showed encouraging results of their structured education program intervention, on the glycemic control in Nigeria as an example of low-middle income countries [11].