Memory of insulin pumps and their record as a source of information about insulin therapy in children and adolescents with type 1 diabetes.
BACKGROUND
This study was designed to provide information regarding basal and bolus insulin dosage in children and adolescents using continuous subcutaneous insulin infusion (CSII) and to evaluate the safety and efficacy of the CSII method in youths.


METHODS
Data from 100 patients (1.6-18 years old) were collected during scheduled visits in an outpatient clinic. The mean duration of diabetes was 4.57 years (range 0.6-16 years), and mean duration of CSII therapy was 1.75 years (range 0.5-3.0 years). Each child had his or her insulin doses reviewed using the Medtronic MiniMed (Northridge, CA) Pumps&Meters software program. At each visit glycosylated hemoglobin (HbA1c) values and growth parameters (weight and height) were assessed, and episodes of severe hypoglycemia and ketoacidosis were recorded.


RESULTS
The mean HbA1c value in our study group was 7.63 +/- 0.09% (range, 5.15-12.5%). Statistically significant better metabolic control was found in children under 10 years of age, in children with lower body mass index (r = 0.33), in patients with a lower contribution of basal insulin to the total daily dose (r = 0.35; P < 0.05), and in boys. Ten percent of participants skipped mealtime boluses, which correlated with their glycemic control; in those children HbA1c was 8.67 +/- 0.57% (r = 0.34; P < 0.05). The mean total daily insulin was 0.79 +/- 0.02 U/kg/day (range, 0.3-2.0 U/kg/day). Basal insulin constituted on average 35.6 +/- 1.1% (5-70%) of the daily insulin dose. We found a statistically significant higher contribution of basal insulin dose in patients who missed mealtime boluses (r = 0.42; P < 0.05) and a significantly lower contribution in pre-pubertal children and in boys (P < 0.05). Around 7% of patients made mistakes in programming the basal insulin.


CONCLUSIONS
CSII may be safely and efficiently used in children with type 1 diabetes in different age groups. This method of treatment requires regular visits to an outpatient clinic, proper education, and frequent revisions of the pump's memory.
Pańkowska
Ewa
E
Department of Pediatric Diabetology and Birth Defects, Medical University of Warsaw, Warsaw, Poland. epankowska@interia.pl
Skórka
Agata
A
Szypowska
Agnieszka
A
Lipka
Maria
M
D000293:Adolescent; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000378:metabolism; D004282:Documentation; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D007223:Infant; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D007331:Insulin Coma / Q000209:etiology; D007332:Insulin Infusion Systems / Q000009:adverse effects / Q000706:statistics & numerical data*; D061268:Insulin Lispro; D008297:Male; D009765:Obesity / Q000097:blood / Q000188:drug therapy; D010353:Patient Education as Topic
D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D061268:Insulin Lispro