title: Impact of insulin pumps on glycaemic control in a pump-naïve paediatric regional population.
abstract: OBJECTIVE
  To examine the clinical impact of insulin-pump therapy for children with type 1 diabetes mellitus (T1DM) in a regional paediatric service, Auckland, New Zealand.
  
  
  METHODS
  Retrospective analysis of children with T1DM from the Starship paediatric diabetes database who started on insulin-pump therapy from 2002 to 2008 compared with the whole T1DM population and with an equal number of non-pump patients matched by age, sex, ethnicity and duration of diabetes.
  
  
  RESULTS
  From 621 subjects with 6680 clinic visits, 75 children were treated with insulin-pump therapy for more than 12 months. Transitioning to insulin-pump treatment was associated with an improvement in HbA1c compared with baseline (-0.3%/year, P < 0.001) for up to 3 years. In contrast, despite similar deprivation scores, non-pump controls showed a continuing trend to higher HbA1C values (+0.2%/year, P < 0.01). The risk of severe hypoglycaemia fell after pump start (from 27 (0-223) to 5 (0-0.91) events/100 patient years) with no change in non-pump controls; the rate of diabetic ketoacidosis remained low in both groups.
  
  
  CONCLUSIONS
  In a pump-naïve regional paediatric population, insulin-pump therapy for T1DM was safe and effective, and associated with sustained improvements in HbA1c and lower risk of hypoglycaemia.
authors.affiliation: The Liggins Institute Department of Physiology, University of Auckland, Auckland, New Zealand. m.debock@auckland.ac.nz
authors.forename: Martin
authors.initials: M
authors.lastname: de Bock
authors.forename: Alistair Jan
authors.initials: AJ
authors.lastname: Gunn
authors.forename: Jean-Ann
authors.initials: JA
authors.lastname: Holt
authors.forename: José G B
authors.initials: JG
authors.lastname: Derraik
authors.forename: Peter
authors.initials: P
authors.lastname: Reed
authors.forename: Wayne
authors.initials: W
authors.lastname: Cutfield
authors.forename: Fran
authors.initials: F
authors.lastname: Mouat
authors.forename: Paul
authors.initials: P
authors.lastname: Hofman
authors.forename: Craig
authors.initials: C
authors.lastname: Jefferies
mesh_terms: D001786:Blood Glucose / Q000187:drug effects*; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy; D005260:Female; D006442:Glycated Hemoglobin; D006776:Hospitals, Pediatric; D006801:Humans; D007003:Hypoglycemia / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems; D008297:Male; D009520:New Zealand / Q000453:epidemiology; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin