title: Continuous subcutaneous insulin infusion (CSII) versus conventional injection therapy in newly diagnosed diabetic children: two-year follow-up of a randomized, prospective trial.
abstract: The effect of continuous subcutaneous insulin infusion (CSII), begun at diagnosis, on blood glucose control and endogenous insulin production was studied in a group of consecutively referred newly diagnosed diabetic children. In a random order, 15 children started CSII (age 9.5 +/- 4.2 (+/- SD) years) and 15 conventional injection therapy (age 7.0 +/- 3.6 years). For 2 years HbA1 and urinary C-peptide were measured monthly, C-peptide responses to glucagon 6-monthly, and insulin antibodies every 3 months. None of the patients requested change of therapy during the study period, but at 28 months 1 adolescent girl changed to injection therapy from CSII. Severe hypoglycaemia was observed once in each group, but ketoacidosis only once, in the injection therapy group. From 2 months after diagnosis onwards the CSII group had significantly lower HbA1 levels. Urinary and plasma C-peptide levels did not differ between the two groups and similar insulin doses were used throughout the study. At the end of the 2 years of therapy, the CSII group had significantly lower insulin antibody levels. The observations suggest that CSII is well accepted in newly diagnosed children and improves metabolic control, but does not prolong endogenous insulin production.
authors.affiliation: Department of Paediatrics, Erasmus University, Rotterdam, The Netherlands.
authors.forename: C E
authors.initials: CE
authors.lastname: de Beaufort
authors.forename: C M
authors.initials: CM
authors.lastname: Houtzagers
authors.forename: G J
authors.initials: GJ
authors.lastname: Bruining
authors.forename: R S
authors.initials: RS
authors.lastname: Aarsen
authors.forename: N C
authors.initials: NC
authors.lastname: den Boer
authors.forename: W F
authors.initials: WF
authors.lastname: Grose
authors.forename: R
authors.initials: R
authors.lastname: van Strik
authors.forename: J J
authors.initials: JJ
authors.lastname: de Visser
mesh_terms: D001786:Blood Glucose / Q000032:analysis; D002096:C-Peptide / Q000097:blood / Q000652:urine; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy* / Q000652:urine; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D007332:Insulin Infusion Systems; D008297:Male; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012016:Reference Values
chemical_list: D001786:Blood Glucose; D002096:C-Peptide; D006442:Glycated Hemoglobin; D007328:Insulin