title: The effectiveness and durability of an early insulin pump therapy in children and adolescents with type 1 diabetes mellitus.
abstract: BACKGROUND
  This study evaluated the predictors of effectiveness and durability of insulin pump therapy in children and adolescents who have initiated continuous subcutaneous insulin infusion (CSII) within 2 years after the diagnosis of type 1 diabetes mellitus (T1DM).
  
  
  METHODS
  The charts of individuals with T1DM using insulin pumps who were treated at our center were reviewed, including subjects with age at onset of <22 years, interval between onset and insulin pump commencement (interval onset-commencement) of <2 years, use of pumps of >1 year, and use of glucose sensors for <4 weeks/year. The primary end point was the mean glycosylated hemoglobin (HbA1c) value (MHbA1c) throughout the follow-up.
  
  
  RESULTS
  From 684 patients treated with insulin pumps, 119 met the inclusion criteria, and 113 were selected for statistical analysis (60 females; age at diabetes onset, 8.9±5.6 years [mean±SD]; follow-up, 4.0±1.8 years; range, 1-8 years; baseline HbA1c, 9.3±1.8%). Only the interval onset-commencement was a linear predictor of the MHbA1c (P=0.01; R(2)=0.089). A significant reduction of the mean yearly HbA1c from baseline throughout all the follow-up was observed (P<0.001). Categorizing the sample into four quartiles on the basis of an increasing interval onset-commencement resulted in levels of MHbA1c significantly lower in the first and second quartiles in comparison with the fourth quartile (7.6±0.8% and 7.8±1.0%, respectively, versus 8.5±0.8%; P<0.001 and P=0.004, respectively).
  
  
  CONCLUSIONS
  The present study suggests that early pump commencement in children and adolescents with T1DM provides lower and more durable HbA1c values than a late commencement. It is possible that an early pump commencement could prolong the honeymoon phase, but we cannot confirm or exclude this hypothesis because the lack of data about C-peptide levels during the follow-up.
authors.affiliation: Regional Reference Center for Diabetology and Insulin Pumps, Department of Internal Medicine and Diabetology, Hospital of Partinico , Partinico (PA), Italy .
authors.forename: Davide
authors.initials: D
authors.lastname: Brancato
authors.forename: Mattia
authors.initials: M
authors.lastname: Fleres
authors.forename: Vito
authors.initials: V
authors.lastname: Aiello
authors.forename: Gabriella
authors.initials: G
authors.lastname: Saura
authors.forename: Alessandro
authors.initials: A
authors.lastname: Scorsone
authors.forename: Lidia
authors.initials: L
authors.lastname: Ferrara
authors.forename: Francesca
authors.initials: F
authors.lastname: Provenzano
authors.forename: Anna
authors.initials: A
authors.lastname: Di Noto
authors.forename: Lucia
authors.initials: L
authors.lastname: Spano
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Provenzano
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D000704:Analysis of Variance; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007003:Hypoglycemia / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects; D007332:Insulin Infusion Systems; D007558:Italy / Q000453:epidemiology; D008297:Male; D008499:Medical Records; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin