Continuous subcutaneous insulin infusion attenuated glycemic instability in preschool children with type 1 diabetes mellitus.
OBJECTIVE
Continuous subcutaneous insulin infusion (CSII) is believed to decrease glycemic instability and hypoglycemia while increasing quality of life compared to insulin injection regimens. To evaluate indices of glycemic control and impact on quality of life, we studied a group of preschool children with type 1 diabetes mellitus (DM) on CSII.


METHODS
Fourteen patients (eight girls and six boys) 3.9 +/- 0.8 years old with DM duration of 2.0 +/- 0.8 years were transitioned from flexible multiple daily insulin (FMDI) (pre-meal aspart and bedtime glargine) to CSII. Patients were evaluated with hemoglobin A(1c) (HbA(1c)) and continuous glucose monitoring quarterly for 1 year. Mean blood glucose (MBG), mean amplitude of glycemic excursion (MAGE), and hypoglycemic events (blood glucose <60 mg/dL) were determined. Patients' parents completed quality of life [TNO-AZL Preschool Children Quality of Life (TAPQoL)] questionnaires for their children at baseline and 1.0 year.


RESULTS
The total daily insulin and the bolus:basal ratio did not change during CSII (0.72 +/- 0.21 vs. 0.74 +/- 0.16 U/kg/day and 2.1 +/- 0.61 vs. 2.40 +/- 0.58 U/kg/day, respectively). There was no change in HbA(1c) (8.0 +/- 0.50% vs. 7.8 +/- 0.40%) or frequency of hypoglycemia (moderate, 92.3 vs. 73.1 events/100 patient-years; severe, 22.5 vs. 17.5 events/100 patient-years). The MBG (213 +/- 94 vs. 185 +/- 79 mg/dL) and frequency (1.9 +/- 1.6 vs. 2.1 +/- 2.2) and duration (nocturnal, 135 +/- 141 vs. 120 +/- 103 min; total, 267 +/- 222 vs. 189 +/- 148 min) of hypoglycemic events did not decrease, whereas MAGE was reduced on CSII (210 +/- 31 vs. 168 +/- 22 mg/dL, P < 0.005). The quality of life subscales on the TAPQoL questionnaire did not change on CSII.


CONCLUSIONS
CSII improved glycemic instability without reducing HbA(1c) or frequency and duration of hypoglycemic events and altering the parent's perception of his or her child's quality of life. CSII improves glycemic instability and is an effective alternative to FMDI therapy in young children with type 1 DM.
Alemzadeh
Ramin
R
Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA. ralemzad@mcw.edu
Palma-Sisto
Paola
P
Holzum
M
M
Parton
Elaine
E
Kicher
J
J
D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism*; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D004334:Drug Administration Schedule; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology / 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 / Q000523:psychology; D008297:Male; D010290:Parents / Q000193:education; D018579:Patient Selection; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin