Factors associated with increased risk of insulin pump discontinuation in pediatric patients with type 1 diabetes.
BACKGROUND
There are few reports on rates and predictors for pump discontinuation in the pediatric population.


OBJECTIVE
To study the rate of and predictors for insulin pump discontinuation among pediatric patients with type 1 diabetes.


METHODS
Medical chart review of 530 patients with type 1 diabetes who had started pump therapy between 2000 and 2008 in our center revealed that 11.3% had discontinued pump use after 3 d to 5 yr; of these, 9.1% discontinued pump use at least 3 months after initiation. Relevant data were retrieved from the files of these patients and from those of 100 randomly assigned pump-treated patients.


RESULTS
The pump discontinuation group had a significantly higher proportion of female patients (75 vs. 46%, p = 0.001) and patients above 10 yr of age (93.8 vs. 80%, p = 0.03) than the reference group. Comparable findings were noted for age at diagnosis, pubertal stage, anthropometric data and duration of diabetes at pump initiation, rate of severe hypoglycemic and diabetic ketoacidosis episodes. There were no between-group differences in number of daily insulin injections and blood glucose measurements before pump treatment. At pump initiation, HbA(1c) was significantly higher in patients discontinuing pump therapy than in the controls (8.6 ± 1.4 vs. 8.1 ± 1.0, p = 0.02). This difference was maintained at the last follow-up visit recorded.


CONCLUSIONS
Almost 90% of our cohort maintained pump therapy. Female gender, age older than 10 years in girls and poor metabolic control at pump initiation were associated with higher risk for pump discontinuation - for such patients intensified individual and family support may serve to maximize persistent pump therapy.
de Vries
Liat
L
The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. liatd@clalit.org.il
Grushka
Yael
Y
Lebenthal
Yael
Y
Shalitin
Shlomit
S
Phillip
Moshe
M
D000293:Adolescent; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems / Q000523:psychology / Q000706:statistics & numerical data*; D008297:Male; D010349:Patient Compliance; D012189:Retrospective Studies; D012306:Risk
D006442:Glycated Hemoglobin; D007328:Insulin