Metabolic control in children with diabetes mellitus who are younger than 6 years at diagnosis: continuous subcutaneous insulin infusion as a first line treatment?
OBJECTIVE
To assess long-term metabolic outcomes in children with diabetes mellitus that was diagnosed when they were <6 years old.


METHODS
A cohort of 66 children with diabetes mellitus that had a duration of at least 5 years and was diagnosed before they were 6 years old. Thirty-four children were treated at diagnosis with multiple daily subcutaneous insulin injections (MDI), and all these children, except 3, were switched to continuous subcutaneous insulin infusion (CSII; group A). Thirty-two children received CSII as initial treatment (group B).


RESULTS
Hemoglobin A1c values were significantly lower in patients receiving CSII than MDI during all the 8 years of follow-up except one (year 1: 6.9%+/-0.9% versus 7.6%+/-1%, P=.011 ; year 4: 7.4%+/-0.8% versus 8.1%+/-0.9%, P=.006; year 7: 7.6%+/-0.5% versus 8.3%+/-0.8%, P=.001). The incidence of severe hypoglycemia was greatly decreased for the CSII group (9.8 versus 22.3 episodes/100 patient-years, P=.016). In group A, hemoglobin A1c values increased during the study period, and in group B, they increased only during the first 2 years and remained constant thereafter. Only 9.1% of patients did not use or abandoned CSII.


CONCLUSIONS
CSII in children<6 years of age enables better long-term metabolic control and lowers the risk of severe hypoglycemia better than MDI, especially when initiated at diagnosis.
Department of Pediatrics, American Memorial Hospital, University Hospital of Reims, Reims, France. vsulmont@chu-reims.fr
Veronique
V
Sulmont
Pierre-François
PF
Souchon
Cécile
C
Gouillard-Darnaud
Anna
A
Fartura
Anne-Sophie
AS
Salmon-Musial
Emeric
E
Lambrecht
Pierre
P
Mauran
Michel
M
Abely
D017668:Age of Onset; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D015994:Incidence; D015918:Infusion Pumps, Implantable; D055104:Infusions, Subcutaneous / Q000379:methods; D007279:Injections, Subcutaneous / Q000379:methods; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood; D008297:Male; D013997:Time Factors; D016896:Treatment Outcome
D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human