Use of insulin pump therapy at nighttime only for children 7-10 years of age with type 1 diabetes.
OBJECTIVE
Because of age-related developmental and cognitive issues, children <10 years of age may not be able to wear an insulin pump safely when they are not under direct parental supervision. The purpose of this study was to determine if insulin pump therapy at nighttime only, when children are at home, could improve fasting and nighttime blood glucose levels without adverse effects.


METHODS
The study cohort consisted of 10 children aged 7-10 years. A randomized crossover design was used to compare nighttime-only pump usage from dinner and throughout the night, combined with a prebreakfast injection of intermediate-acting NPH and rapid-acting lispro insulin, with 3 insulin injections per day. Comparisons were made among mean blood glucose values and percentage of blood glucose levels within the target range (70-150 mg/dl) before meals, at bedtime, and at 3:00 A.M.; serum fructosamine levels; and scores on measures of adherence and fear of hypoglycemia.


RESULTS
Compared with baseline levels, the use of the pump resulted in a significant decrease in the mean average (P < 0.001), breakfast (P < 0.0001), and 3:00 A.M. (P < 0.003) blood glucose levels. There was a decrease in the percentage of blood glucose values less than the target range (P < 0.01) and in fructosamine (P < 0.01) values and an increase in the percentage of blood glucose levels within the target range (P < 0.03).


CONCLUSIONS
Nighttime-only insulin pump therapy may be a viable alternative that young children can use to improve glycemia when they are not capable of independently managing an insulin pump.
Kaufman
F R
FR
Department of Pediatrics, University of Southern California School of Medicine, USA. fkaufman@chla.usc.edu
Halvorson
M
M
Kim
C
C
Pitukcheewanont
P
P
D002648:Child; D018592:Cross-Over Studies; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D006801:Humans; D007267:Injections; D007328:Insulin / Q000008:administration & dosage / Q000031:analogs & derivatives; D007332:Insulin Infusion Systems; D061268:Insulin Lispro; D007336:Insulin, Isophane / Q000008:administration & dosage; D012890:Sleep
D007328:Insulin; D061268:Insulin Lispro; D007336:Insulin, Isophane