title: Persistence of benefits of continuous subcutaneous insulin infusion in very young children with type 1 diabetes: a follow-up report.
abstract: OBJECTIVE
  Use of continuous subcutaneous insulin infusion (CSII) has increased dramatically in recent years, and pump therapy has been shown to be a safe and effective alternative to multiple daily injections in adults and older pediatric patients with type 1 diabetes. Its use in very young children, however, has been limited, although this group might be expected to benefit the most from CSII. The objective of this study was to analyze the CSII efficacy and safety data in very young children with type 1 diabetes from our Diabetes Clinic database.
  
  
  METHODS
  Glycosylated hemoglobin (HbA1c), severe hypoglycemia (SH), and ketoacidosis (DKA) in the year before CSII were compared with corresponding values during pump treatment in all children who started CSII before age 7.
  
  
  RESULTS
  Sixty-five children (mean age: 4.5 y at CSII initiation; range: 1.4-6.9 years; 28 girls; 3 black, 1 Hispanic) were analyzed for >162 patient-years of follow-up. Mean HbA(1c) (7.4 +/- 1.0 prepump) decreased to 7.0 +/- 0.9 after 12 months of CSII and continued to improve even after 4 years on CSII. The rate of SH was reduced by 53% (from 78 to 37/100 patient-years). Children who received daytime care from paid caregivers (n = 26) experienced significant reductions in HbA1c and hypoglycemia frequency. There were no episodes of DKA requiring emergency treatment in the year before CSII and 4 episodes (4 per 100 patient-years) after transition to pump.
  
  
  CONCLUSIONS
  CSII is a durable and effective means of optimizing glycemic control in very young patients with type 1 diabetes and may be superior to multiple daily injections in minimizing the risk of severe hypoglycemia in this age group. Employment of paid caregivers does not preclude safe and effective use of CSII.
authors.affiliation: Department of Pediatrics, Yale University School of Medicine, PO Box 208064, 333 Cedar St, New Haven, Connecticut 06520, USA. stuart.weinzimer@yale.edu
authors.forename: Stuart A
authors.initials: SA
authors.lastname: Weinzimer
authors.forename: JoAnn H
authors.initials: JH
authors.lastname: Ahern
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Doyle
authors.forename: Miranda R
authors.initials: MR
authors.lastname: Vincent
authors.forename: James
authors.initials: J
authors.lastname: Dziura
authors.forename: Amy T
authors.initials: AT
authors.lastname: Steffen
authors.forename: William V
authors.initials: WV
authors.lastname: Tamborlane
mesh_terms: D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy*; D016883:Diabetic Ketoacidosis / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D007003:Hypoglycemia / Q000517:prevention & control*; D007223:Infant; D007332:Insulin Infusion Systems
chemical_list: D006442:Glycated Hemoglobin