Establishing glycaemic control with continuous subcutaneous insulin infusion in children and adolescents with type 1 diabetes: experience of the PedPump Study in 17 countries.
OBJECTIVE
To assess the use of paediatric continuous subcutaneous infusion (CSII) under real-life conditions by analysing data recorded for up to 90 days and relating them to outcome.


METHODS
Pump programming data from patients aged 0-18 years treated with CSII in 30 centres from 16 European countries and Israel were recorded during routine clinical visits. HbA(1c) was measured centrally.


RESULTS
A total of 1,041 patients (age: 11.8 +/- 4.2 years; diabetes duration: 6.0 +/- 3.6 years; average CSII duration: 2.0 +/- 1.3 years; HbA(1c): 8.0 +/- 1.3% [means +/- SD]) participated. Glycaemic control was better in preschool (n = 142; 7.5 +/- 0.9%) and pre-adolescent (6-11 years, n = 321; 7.7 +/- 1.0%) children than in adolescent patients (12-18 years, n = 578; 8.3 +/- 1.4%). There was a significant negative correlation between HbA(1c) and daily bolus number, but not between HbA(1c) and total daily insulin dose. The use of <6.7 daily boluses was a significant predictor of an HbA(1c) level >7.5%. The incidence of severe hypoglycaemia and ketoacidosis was 6.63 and 6.26 events per 100 patient-years, respectively.


CONCLUSIONS
This large paediatric survey of CSII shows that glycaemic targets can be frequently achieved, particularly in young children, and the incidence of acute complications is low. Adequate substitution of basal and prandial insulin is associated with a better HbA(1c).
Danne
T
T
Kinderkrankenhaus auf der Bult, Hanover, Janusz-Korczak-Allee 12, 30173 Hanover, Germany. danne@hka.de
Battelino
T
T
Jarosz-Chobot
P
P
Kordonouri
O
O
Pánkowska
E
E
Ludvigsson
J
J
Schober
E
E
Kaprio
E
E
Saukkonen
T
T
Nicolino
M
M
Tubiana-Rufi
N
N
Klinkert
C
C
Haberland
H
H
Vazeou
A
A
Madacsy
L
L
Zangen
D
D
Cherubini
V
V
Rabbone
I
I
Toni
S
S
de Beaufort
C
C
Bakker-van Waarde
W
W
van den Berg
N
N
Volkov
I
I
Barrio
R
R
Hanas
R
R
Zumsteg
U
U
Kuhlmann
B
B
Aebi
C
C
Schumacher
U
U
Gschwend
S
S
Hindmarsh
P
P
Torres
M
M
Shehadeh
N
N
Phillip
M
M
D000293:Adolescent; D001786:Blood Glucose / Q000378:metabolism*; D002648:Child; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000188:drug therapy*; D004334:Drug Administration Schedule; D005060:Europe; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use; D007332:Insulin Infusion Systems; D012189:Retrospective Studies
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin