Improved glycemic control after long-term insulin pump use in pediatric patients with type 1 diabetes.
BACKGROUND
There are currently few data available on the long-term use of continuous subcutaneous insulin infusion (CSII) (insulin pump) therapy in children.


METHODS
Charts from 291 youth with type 1 diabetes (T1D) who were treated with CSII therapy for at least 1 year were reviewed. Data analysis included hemoglobin A(1c)(HbA(1c)) values, body mass index (BMI) values, and the occurrence of severe hypoglycemia (SH) or diabetic ketoacidosis (DKA) events.


RESULTS
For the 291 patients, the mean age (+/-SD) for beginning CSII therapy was 13.3 +/- 3.7 years. The mean duration of CSII was 3.7 +/- 1.9 years (range 1-9 years). The baseline HbA(1c) value was 8.7 +/- 1.0%, compared to 8.2 +/- 0.9% after 1 year (P < 0.0001). The most recent value for all patients was 8.3 +/- 1.3% (P < 0.0001 compared to the baseline values for the same subjects). There was no advantage in glycemic control in the teen years as a result of initiating CSII in the pre-teen years compared to the teen years. SH events decreased from 9.06 events per 100 patient-years before CSII therapy to 7.96 events per 100 patient-years while on CSII therapy. The incidence of DKA increased from 1.39 events pre-CSII to 3.98 events per 100 patient-years while on CSII therapy. BMI z-scores showed a nonsignificant increase.


CONCLUSIONS
The long-term use of CSII in pediatric patients is beneficial in lowering mean HbA(1c) levels and the number of SH events. However, there was an increase in the number of DKA episodes.
Scrimgeour
Laura
L
Department of Pediatrics, Barbara Davis Center for Childhood Diabetes, University of Colorado Health Sciences Center, Aurora, CO 80045, USA.
Cobry
Erin
E
McFann
Kim
K
Burdick
Pat
P
Weimer
Casey
C
Slover
Robert
R
Chase
H Peter
HP
D000293:Adolescent; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism*; D015992:Body Mass Index; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D016883:Diabetic Ketoacidosis / Q000453:epidemiology; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007003:Hypoglycemia / Q000453:epidemiology; D007332:Insulin Infusion Systems; D008137:Longitudinal Studies; D012189:Retrospective Studies
D001786:Blood Glucose; D006442:Glycated Hemoglobin