title: Poor adherence to integral daily tasks limits the efficacy of CSII in youth.
abstract: OBJECTIVE
  Many young people experience improved glycemia with continuous subcutaneous insulin infusion (CSII) regimens; however, sustained glycemic benefit eludes a significant proportion. Our aims were to assess adherence to recommended CSII-related behaviors in a representative pediatric cohort and to identify potentially modifiable behaviors that impact on HbA1c in youth.
  
  
  METHODS
  Data uploaded from insulin pump devices of 100 youth with type 1 diabetes were analyzed.
  
  
  RESULTS
  Ability to translate recommended behaviors into daily self-management varied widely in youth. Mean bolus frequency was 6.1/d; however, 69/100 entered <4 blood glucose levels (BGL)/d. HbA1c decreased by 0.2% for each additional BGL (p=0.001) and bolus event (p<0.001) per day. Prandial insulin omission was common and associated with significantly increased HbA1c. On average, if breakfast insulin was missed ≥4 times per fortnight, HbA1c increased 1.0% (p<0.001). If one or more days per fortnight with ≤2 food boluses/d were recorded, then HbA1c increased 0.8% (p=0.001). Increasing age and duration of CSII correlated with poorer adherence to recommended behaviors.
  
  
  CONCLUSIONS
  Glycemic advantage obtained with CSII regimens is closely related to the manner in which CSII is employed. Poor adherence to integral CSII-related tasks is frequently encountered in adolescents and limits the efficacy of CSII in these youth.
authors.affiliation: Department of Endocrinology and Diabetes, The Royal Children's Hospital and Murdoch Children's Research Institute, Melbourne, Australia. michele.oconnell@rch.org.au
authors.forename: M A
authors.initials: MA
authors.lastname: O'Connell
authors.forename: S
authors.initials: S
authors.lastname: Donath
authors.forename: F J
authors.initials: FJ
authors.lastname: Cameron
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000187:drug effects; D015190:Blood Glucose Self-Monitoring / Q000295:instrumentation / Q000379:methods; D002648:Child; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems / Q000523:psychology*; D008297:Male; D010349:Patient Compliance / Q000706:statistics & numerical data*; D012648:Self Care / Q000295:instrumentation / Q000379:methods
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human