Safety and effectiveness of insulin pump therapy in children and adolescents with type 1 diabetes.
OBJECTIVE
To evaluate the safety and effectiveness of insulin pump therapy in children and adolescents with type 1 diabetes.


METHODS
All 95 patients who began insulin pump therapy at Johns Hopkins Hospital between January 1990 and December 2000 were included in the study. The mean age was 12.0 years (range 4-18), and 29% of the patients were <10 years old. Data were obtained by chart review beginning 6-12 months before pump start. The median duration of follow-up was 28 months.


RESULTS
There was a small but significant decrease in HbA(1c) at 3-6 months after pump start (7.7 vs. 7.5%; P = 0.03). HbA(1c) levels then gradually increased and remained elevated after 1 year of follow-up; however, this association was confounded by age and diabetes duration, both of which were associated with higher HbA(1c) levels. After adjusting for duration and age, mean HbA(1c) after pump start was significantly lower than before pump start (7.7 vs. 8.1%; P < 0.001). The number of medical complications (diabetic ketoacidosis, emergency department visits) was similar before and after pump start. There were fewer hypoglycemic events after pump start (12 vs. 17, rate ratio 0.46, 95% CI 0.21-1.01).


CONCLUSIONS
This study suggests that pump therapy is safe and effective in selected children and adolescents with type 1 diabetes.
Plotnick
Leslie P
LP
Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland, USA. lplotni@jhmi.edu
Clark
Loretta M
LM
Brancati
Frederick L
FL
Erlinger
Thomas
T
D000293:Adolescent; D015142:Baltimore; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D016883:Diabetic Ketoacidosis / Q000453:epidemiology; D004630:Emergencies / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007003:Hypoglycemia / Q000453:epidemiology; D015994:Incidence; D007239:Infections / Q000453:epidemiology; D007332:Insulin Infusion Systems / Q000009:adverse effects / Q000592:standards*; D008297:Male; D012189:Retrospective Studies; D012449:Safety; D013997:Time Factors; D016896:Treatment Outcome; D044465:White People
D006442:Glycated Hemoglobin