Feasibility of continuous subcutaneous insulin infusion and daily supplemental insulin glargine injection in children with type 1 diabetes.
BACKGROUND
Continuous subcutaneous insulin infusion (CSII) is an effective method of insulin substitution with increased risk of hypoglycemia and diabetic ketoacidosis (DKA) in rare situations. The lack of subcutaneous long-acting insulin and short half-life of serum insulin increases the risk of ketosis and DKA following CSII failure. We evaluated the metabolic effects of CSII with and without daily supplemental long-acting insulin glargine in a group of young children switched to CSII from multiple daily insulin (premeal aspart + glargine) to either CSII plus daily glargine (CSII + G) or CSII therapy.


METHODS
From retrospective clinic data, self-monitored blood glucose (SMBG), hemoglobin A1c (HbA(1c)), hypoglycemic episodes, and body mass index (BMI) were obtained from 12 patients (five girls, seven boys; 7.7 +/- 1.8 years) on CSII + G and 12 age- and gender-matched patients (five girls, seven boys; 7.7 +/- 2.1 years) on CSII with similar baseline HbA(1c) and BMI were reviewed over a 1.0-year period.


RESULTS
The insulin glargine dose in the CSII + G group was 30.6 +/- 12.4% (range, 13.9-53.3%) of daily basal insulin dose. Both groups had similar total daily insulin and bolus:basal insulin at baseline and at 1.0 year. Glycemic control improved in the CSII + G (SMBG, 195.5 +/- 47.3 vs. 156.8 +/- 36.8 mg/dL, P < 0.05; HbA(1c), 8.1 +/- 0.9% vs. 7.4 +/- 0.4%, P < 0.02) and CSII (SMBG, 198.7 +/- 45.7 vs. 161.4 +/- 30.9 mg/dL, P < 0.05; HbA(1c), 8.2 +/- 0.4% vs. 7.7 +/- 0.5%, P < 0.01) groups without significant changes in hypoglycemic episodes and BMI. There were no DKA episodes despite three emergency room visits for hyperglycemia and ketosis due to catheter dislodgement only in the CSII group.


CONCLUSIONS
CSII therapy with or without daily insulin glargine improved glycemic control without changes in the rate of hypoglycemia and DKA, suggesting that this treatment regimen is feasible and may also prevent development of hyperglycemia and ketosis or even DKA.
Alemzadeh
Ramin
R
Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA. ralemzad@mcw.edu
Parton
Elaine A
EA
Holzum
Mary K
MK
D015190:Blood Glucose Self-Monitoring; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy*; D003927:Diet, Diabetic; D004040:Dietary Carbohydrates; D004305:Dose-Response Relationship, Drug; D015444:Exercise; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage* / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D000069036:Insulin Glargine; D007332:Insulin Infusion Systems; D049528:Insulin, Long-Acting; D008297:Male; D010353:Patient Education as Topic; D012189:Retrospective Studies
D004040:Dietary Carbohydrates; D007328:Insulin; D049528:Insulin, Long-Acting; D000069036:Insulin Glargine