Insulin pump therapy in toddlers and preschool children with type 1 diabetes mellitus.
OBJECTIVE
To test whether glycemic control in young children could be achieved more effectively and safely by using continuous insulin infusions administered by insulin pumps.


METHODS
We analyzed the effects of pump therapy in nine toddlers in whom type 1 diabetes developed between the ages of 10 and 40 months. After a mean of 13.7 months of therapy with multiple daily injections, patients were treated with insulin pumps for periods ranging from 7 to 19 months (mean, 12.7 months).


RESULTS
Before initiation of pump therapy, HbA1c levels averaged 9.5% +/- 0.4%, and patients had a mean of 0.52 episodes per month of severe hypoglycemia (uncontrolled shaking, inconsolable crying, disorientation, or seizures). After initiation of pump therapy, HbA1c levels declined to 7.9% +/- 0.3% (P <.001 vs prepump levels), and the incidence of severe hypoglycemia decreased to 0.09 episodes per month (P <.05). Normal linear growth and weight gain were maintained during pump therapy. There were no changes in the frequency of physician or emergency room visits for acute hyperglycemia or ketoacidosis. However, the frequency of parental contacts with health personnel declined by >80%, reflecting increasing parental confidence and independence in diabetic care. Subjective assessments revealed significant improvements in quality of life and high levels of satisfaction with pump therapy.


CONCLUSIONS
Insulin pump therapy may provide an effective alternative for selected preschool children with type 1 diabetes.
Litton
Jean
J
Division of Pediatric Endocrinology and Diabetes, Duke University Medical Center, Durham, North Carolina 27710, USA.
Rice
Alan
A
Friedman
Nancy
N
Oden
Jon
J
Lee
Mary M
MM
Freemark
Michael
M
D002669:Child Welfare; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000209:etiology; D016883:Diabetic Ketoacidosis / Q000188:drug therapy / Q000209:etiology; D004305:Dose-Response Relationship, Drug; D004632:Emergency Medical Services; D005260:Female; D006442:Glycated Hemoglobin / Q000187:drug effects / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007223:Infant; D007229:Infant Welfare; D007328:Insulin / Q000627:therapeutic use*; D007332:Insulin Infusion Systems; D008297:Male; D009657:North Carolina; D010820:Physicians; D012720:Severity of Illness Index; D016896:Treatment Outcome; D015430:Weight Gain / Q000187:drug effects
D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin