Insulin pump therapy in preschool children with type 1 diabetes mellitus improves glycemic control and decreases glucose excursions and the risk of hypoglycemia.
BACKGROUND
Hypoglycemia in preschool children limits the effectiveness of insulin therapy. Continuous subcutaneous insulin infusion (CSII) is not widely used in this group.


OBJECTIVE
This study was designed (1) to test the hypothesis that compared with twice-daily insulin injection, CSII decreases the SD of the mean daily blood glucose (BG) and improves glycemic control and (2) to evaluate the effect of CSII on parental anxiety using the Parental Stress Index (PSI) scale.


METHODS
Ten subjects <6 years of age and receiving insulin injections were recruited. Each underwent two 72-h CGMS (Medtronic Minimed, Northridge, CA) monitoring periods and then was started on CSII and re-monitored 3 and 6 months later. We assessed the effects of CSII on the mean BG and SD of BG values, A1c, PSI scores, and number, distribution, and duration of hypoglycemic episodes.


RESULTS
Pooled pre- and post-CSII data were compared. There was a 22% decrease in the BG variability (mean +/- SD 93 +/- 19 mg/dL vs. 72 +/- 5 mg/dL; P = 0.02) and a 13% decrease in A1c (8.6 +/- 0.8% vs. 7.5 +/- 0.7%; P = 0.01). There was a decrease in the 24-h median number and duration of hypoglycemic episodes [1.16 vs. 0 episodes/24 h (P = 0.01) and 1.19 vs. 0.05 h/24 h (P = 0.01), respectively], as well as the median number and duration of nighttime episodes [0.83 vs. 0 episode/night (P = 0.008) and 0.98 vs. 0 h/night (P = 0.008), respectively]. We found no statistically significant change in the PSI score.


CONCLUSIONS
CSII in preschool children is feasible and safe. Pump therapy reduced the glycemic excursions and decreased hypoglycemia duration and frequency.
Jeha
George S
GS
Pediatric Endocrinology and Metabolism Section, Clinical Care Center, Texas Children's Hospital, Baylor College of Medicine, Houston 77030-2399, USA. gsjeha@texaschildrenhospital.org
Karaviti
Lefkothea P
LP
Anderson
Barbara
B
Smith
E O'Brian
EO
Donaldson
Susan
S
McGirk
Toniean S
TS
Haymond
Morey W
MW
D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism*; D015190:Blood Glucose Self-Monitoring; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy* / Q000378:metabolism; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007003:Hypoglycemia / Q000517:prevention & control; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems; D008297:Male; D012307:Risk Factors
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin