title: Continuous subcutaneous insulin infusion in preschool children: butt or tummy, which is the best infusion set site?
abstract: BACKGROUND
  Choosing the right infusion set site can be an important factor in obtaining good glycemic control, especially in very young children. In an attempt to identify the best infusion site, we performed a crossover study in six preschool children with type 1 diabetes using insulin pump therapy.
  
  
  METHODS
  We enrolled six patients 5.2±0.7 years old (range, 4-6 years), with type 1 diabetes for more than 1.5 years, using insulin pump therapy for at least 6 months. For each patient, body mass index, glycated hemoglobin, and all data downloaded from the system were evaluated on two occasions: the first with the infusion set placed on the buttock and the second on the abdomen, each for 3 days. The order of infusion set placement was randomized. Mean capillary blood glucose, mean continuous glycemia, mean area under the curve (AUC) using the trapezoidal rule for both >140 mg/dL and <70 mg/dL, insulin daily dose, carbohydrate/insulin ratio, total basal insulin, total bolus insulin, and mean amplitude of glucose excursions (MAGE) were evaluated.
  
  
  RESULTS
  Mean glycemic values, mean AUC >140 mg/dL, and MAGE were significantly lower when the infusion set was placed on the buttock versus the abdomen (144.6±31.9 mg/dL vs. 166.0±34.8 mg/dL [P=0.000], 28.4±18.3% vs. 48.8±28.2% [P=0.000], and 32±10 vs. 60±15 mg/dL [P<0.001], respectively), whereas mean AUC <70 mg/dL was higher (1.47±2.77% vs. 0.87±1.03% [P<0.001]).
  
  
  CONCLUSIONS
  The present findings suggest that preschool children with type 1 diabetes using insulin pump therapy could benefit from inserting the infusion set in the buttock instead of the abdomen.
authors.affiliation: 1 Department of Pediatrics, Second University of Naples , Naples, Italy .
authors.forename: Angela
authors.initials: A
authors.lastname: Zanfardino
authors.forename: Dario
authors.initials: D
authors.lastname: Iafusco
authors.forename: Alessia
authors.initials: A
authors.lastname: Piscopo
authors.forename: Alessandra
authors.initials: A
authors.lastname: Cocca
authors.forename: Pasquale
authors.initials: P
authors.lastname: Villano
authors.forename: Santino
authors.initials: S
authors.lastname: Confetto
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Caredda
authors.forename: Stefania
authors.initials: S
authors.lastname: Picariello
authors.forename: Loredana
authors.initials: L
authors.lastname: Russo
authors.forename: Francesca
authors.initials: F
authors.lastname: Casaburo
authors.forename: Assunta S
authors.initials: AS
authors.lastname: Rollato
authors.forename: Emilia
authors.initials: E
authors.lastname: Forgione
authors.forename: Gianvincenzo
authors.initials: G
authors.lastname: Zuccotti
authors.forename: Francesco
authors.initials: F
authors.lastname: Prisco
authors.forename: Andrea E
authors.initials: AE
authors.lastname: Scaramuzza
mesh_terms: D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D000005:Abdomen; D019540:Area Under Curve; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D002081:Buttocks; D018592:Cross-Over Studies; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy; D006442:Glycated Hemoglobin / Q000378:metabolism; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007279:Injections, Subcutaneous / Q000379:methods; D007328:Insulin / Q000008:administration & dosage; D012869:Skin Absorption; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human; D007004:Hypoglycemic Agents; D007328:Insulin