Metabolic control with insulin pump therapy: the Waikato experience.
OBJECTIVE
To report the effect of insulin pump therapy on glycaemic control and on hypoglycaemia and ketosis rates in Type 1 diabetic patients.


METHODS
A retrospective audit of the management of patients with Type 1 diabetes treated with insulin pump therapy at the Waikato Diabetes Service (Hamilton, New Zealand) between September 1997 and December 2004.


RESULTS
The data of 105 patients currently on continuous subcutaneous insulin infusion (CSII) at the time of data collection were examined. CSII use had occurred for a mean of 3.0+/-2.6 years. HbA1c% improved significantly from 8.9+/-1.3% to 7.9+/-1.0% (P<0.001) at 3 months and 7.9+/-0.95% (P<0.001) at 6 months post CSII. This reduction was maintained after 1, 2, and 3 years and the difference was statistically significant (P<0.001). In the adolescent subgroup (n=27) we observed a similar significant reduction in HbA1c% that was maintained after 1 year of pump therapy. The incidence of severe hypoglycaemia was reduced from 0.75 cases per patient-year during multiple daily injection (MDI) pre-pump to 0.05 cases per patient-year during CSII (P<0.001). In some cases hypoglycaemia awareness was restored. There was no evidence to suggest increased tendency for diabetic ketoacidosis (DKA) with continuing use of insulin pumps. Conclusion Our experience showed that insulin pump therapy was effective and safe for both adults and adolescents with Type 1 diabetes. The reduction in HbA1c% was both statistically and clinically highly significant. Wider usage of this technology in New Zealand is warranted.
Reda
Elham
E
Department of Diabetes and Endocrinology, Waikato Hospital, Hamilton. RedaE@waikatodhb.govt.nz
Von Reitzenstein
Angelica
A
Dunn
Peter
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D001786:Blood Glucose; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D016883:Diabetic Ketoacidosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy; D007003:Hypoglycemia / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007260:Infusion Pumps; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D012189:Retrospective Studies
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin