Continuous subcutaneous insulin infusion and multiple dose of insulin regimen display similar patterns of blood glucose excursions in pediatric type 1 diabetes.
BACKGROUND
Continuous subcutaneous insulin infusion (CSII) is believed to decrease glycemic variability and clinical hypoglycemia compared with the multiple daily insulin (MDI) regimen. To compare the indices of glycemic instability between CSII and MDI, we analyzed the continuous glucose monitoring system (CGMS) (Medtronic MiniMed, Northridge, CA) profiles of a group of children with type 1 diabetes mellitus with history of frequent blood glucose (BG) fluctuations and hypoglycemia.


METHODS
Data from 14 (nine girls, five boys) patients (3.9-16.8 years old) on CSII and 14 age- and sex-matched (nine girls, five boys) patients (3.9-16.0 years old) on MDI with similar glycemic control (hemoglobin A1c: 7.9 +/- 1.0% vs. 7.9 +/- 1.5%) and body mass index (BMI) (20.1 +/- 4.3 vs. 19.9 +/- 4.1 kg/m(2)) were evaluated by the CGMS. Mean BG (MBG), absolute means of daily differences (MODD), mean amplitude of glycemic excursion (MAGE), and number of hypoglycemic events (BG <60 mg/dL) for 48 h were calculated.


RESULTS
The MBG, MODD, MAGE, and number and mean duration of hypoglycemia events in the CSII group were similar to those in the MDI group. The MAGE had an inverse correlation with age (CSII: r (2) = 0.52, P = 0.003; MDI: r (2) = 0.29, P < 0.04) and BMI (CSII: r (2) = 0.38, P < 0.02; MDI: r (2) = 0.71, P < 0.0002). However, there was a positive relationship between MAGE and bolus:basal insulin ratio in the CSII (r (2) = 0.28, P < 0.05) and MDI (r (2) = 0.33, P < 0.03) groups. Also, the MAGE had a positive correlation with frequency of hypoglycemic events in the CSII (r (2) = 0.44, P < 0.01) and MDI (r (2) = 0.35, P < 0.03) groups.


CONCLUSIONS
The CSII and MDI regimens in children and adolescents with comparable glycemic control displayed similar patterns of glycemic excursions, implying that factors influencing glycemic instability in pediatric type 1 diabetes mellitus appear to be independent of treatment modality.
Alemzadeh
Ramin
R
Children's Hospital of Wisconsin Diabetes Center, Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA. ralemzad@mcw.edu
Palma-Sisto
Paola
P
Parton
E A
EA
Holzum
M K
MK
D000293:Adolescent; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism*; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D007332:Insulin Infusion Systems; D008297:Male
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin