Durability of insulin pump use in pediatric patients with type 1 diabetes.
OBJECTIVE
To examine longitudinal outcomes, rate of and reasons for discontinuation, and predictors of insulin pump success in a cohort of youth initiating pump therapy.


METHODS
We followed a cohort of youth with type 1 diabetes (n = 161) starting the pump between 1998 and 2001 and recorded natural history of treatment.


RESULTS
At pump start, patients (71% female) had a mean age of 14.1 +/- 3.7 years, diabetes duration of 7.1 +/- 4.0 years, daily blood glucose monitoring (BGM) frequency of 4.0 +/- 1.2, a daily insulin dose of 1.0 +/- 0.3 units/kg, and an HbA(1c) (A1C) of 8.4 +/- 1.4%. After 1 year, mean daily BGM frequency was 4.5 +/- 1.7, daily insulin dose was 0.8 +/- 0.2 units/kg, and A1C was 8.1 +/- 1.3% (all baseline versus 1-year data, P < 0.01). As of 2005, 29 patients (18%) had resumed injection therapy at a mean age of 17.0 +/- 2.9 years after a mean duration of pump use of 2.1 +/- 1.3 years. BGM frequency at baseline and at 1 year was significantly lower in the patients who resumed injection therapy (P < 0.02). In addition, patients who remained on the pump had lower A1C than those who resumed injection therapy at both 1 year (P = 0.04) and at the most recent clinic visit (P = 0.01).


CONCLUSIONS
After an average of 3.8 years, >80% of pediatric patients maintained pump therapy with preservation of baseline A1C. Patients discontinuing the pump were less adherent and did not achieve equivalent glycemic benefit compared with continued users; these patients require ongoing support aimed at improving adherence and outcomes.
Wood
Jamie R
JR
Pediatric, Adolescent, and Young Adult Section, Genetics and Epidemiology Section, Joslin Diabetes Center, One Joslin Place, Boston, MA 02215, USA.
Moreland
Elaine C
EC
Volkening
Lisa K
LK
Svoren
Britta M
BM
Butler
Deborah A
DA
Laffel
Lori M B
LM
D000293:Adolescent; D002648:Child; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects; D007332:Insulin Infusion Systems / Q000009:adverse effects; D008297:Male; D010349:Patient Compliance; D017060:Patient Satisfaction; D016896:Treatment Outcome
D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin