Insulin pump therapy in type 1 diabetes mellitus.
OBJECTIVE
To review the current experience with insulin pump therapy in children and adolescents in order to guide pediatricians regarding indications and complications.


METHODS
Systematic review of articles published in the literature referring to the use of insulin pump therapy, indications, complications and response to treatment. All articles published between 1995 and 2005 and appearing in the MEDLINE and LILACS databases were reviewed. The keywords were: insulin pump, type 1 diabetes mellitus and diabetes mellitus. The articles covering the subject of interest and referring to children and adolescents were selected.


RESULTS
Insulin pump therapy is not required for all patients with type 1 diabetes, since intensive treatments produce very similar results in terms of glycated hemoglobin and control of complications over the medium and long terms. However, the pump allows for greater comfort for patients, with less rigid meal schedules and better quality of life. The first requirement for patients intending to use the pump is getting used to having a device attached to the body and following strict glucose control; otherwise, pump therapy is not advantageous. Complications are rare due to the technologies currently available. The cost, however, is greater than with conventional treatments.


CONCLUSIONS
The development of infusion pumps and glucose monitors, including continuous monitoring systems, will lead to "intelligent pumps," so that a true "artificial pancreas" will be available, which can even be implanted in the patient, allowing non-diabetic persons to lead a normal life.
Liberatore
Raphael Del Roio
Rdel R
Departaments de Pediatria e Cirurgia Pediátrica, Faculdade de Medicina de São José do Rio Preto, Rua Ondina 54, CEP 15015-205 São José do Rio Preto, SP, Brazil. liberat@famerp.br
Damiani
Durval
D
D000293:Adolescent; D015190:Blood Glucose Self-Monitoring; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000191:economics; D016883:Diabetic Ketoacidosis / Q000209:etiology; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D015918:Infusion Pumps, Implantable / Q000009:adverse effects / Q000191:economics; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems / Q000009:adverse effects / Q000191:economics; D010353:Patient Education as Topic
D007004:Hypoglycemic Agents; D007328:Insulin