Insulin pump use in young children in the T1D Exchange clinic registry is associated with lower hemoglobin A1c levels than injection therapy.
Insulin delivery via injection and continuous subcutaneous insulin infusion (CSII) via insulin pump were compared in a cross-sectional study (n = 669) and retrospective longitudinal study (n = 1904) of young children (<6 yr) with type 1 diabetes (T1D) participating in the T1D Exchange clinic registry. Use of CSII correlated with longer T1D duration (p < 0.001), higher parental education (p < 0.001), and annual household income (p < 0.006) but not with race/ethnicity. Wide variation in pump use was observed among T1D Exchange centers even after adjusting for these factors, suggesting that prescriber preference is a substantial determinant of CSII use. Hemoglobin A1c (HbA1c) was lower in pump vs. injection users (7.9 vs. 8.5%, adjusted p < 0.001) in the cross-sectional study. In the longitudinal study, HbA1c decreased after initiation of CSII by 0.2%, on average (p < 0.001). Frequency of a severe hypoglycemia (SH) event did not differ in pump vs. injection users (p = 0.2). Frequency of ≥1 parent-reported diabetic ketoacidosis (DKA) event in the prior year was greater in pump users than injection users (10 vs. 8%, p = 0.04). No differences between pump and injection users were observed for clinic-reported DKA events. Children below 6 yr have many unique metabolic characteristics, feeding behaviors, and care needs compared with older children and adolescents. These data support the use of insulin pumps in this youngest age group, and suggest that metabolic control may be improved without increasing the frequency of SH, but care should be taken as to the possibly increased risk of DKA.
Division of Pediatric Endocrinology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Scott M
SM
Blackman
Dan
D
Raghinaru
Saleh
S
Adi
Jill H
JH
Simmons
Laurie
L
Ebner-Lyon
H Peter
HP
Chase
William V
WV
Tamborlane
Desmond A
DA
Schatz
Jennifer M
JM
Block
Jean C
JC
Litton
Vandana
V
Raman
Nicole C
NC
Foster
Craig R
CR
Kollman
Stephanie N
SN
DuBose
Kellee M
KM
Miller
Roy W
RW
Beck
Linda A
LA
DiMeglio
D015190:Blood Glucose Self-Monitoring / Q000295:instrumentation / Q000379:methods; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D007223:Infant; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008297:Male; D012042:Registries / Q000706:statistics & numerical data; D012189:Retrospective Studies
D006442:Glycated Hemoglobin; D007328:Insulin; C517652:hemoglobin A1c protein, human
continuous subcutaneous insulin infusion; insulin delivery; type 1 diabetes mellitus