title: Characterization of metabolic responders on CSII treatment amongst children and adolescents in Denmark from 2007 to 2013.
abstract: OBJECTIVE
  This prospective study aimed to identify and estimate the frequency of responders offered Continuous subcutaneous insulin infusion (CSII) from baseline data and during follow-up, and secondly to characterize CSII users with good adherence to pump therapy among 463 children and adolescents with Type 1 diabetes mellitus.
  
  
  METHODS
  A response was defined as lowering HbA1c with 1% or achieving an HbA1c<7.5% (58 mmol/mol). Good adherence was defined as measuring ≥7 self monitored blood glucoses (SMBGs) and taking ≥7 boluses daily. Logistic regression was used to estimate the effect of demographic and clinical variables prior to and during pump treatment.
  
  
  RESULTS
  At 24 months follow-up 32% qualified as responders. Stratifying for age at onset, 45% of the children aged <6 yrs qualified as responders vs. 32% and 28% of the youngsters and adolescents aged 6-12 yrs. and 12-19 yrs., respectively (p=0.02). Responders were characterized by their HbA1c-level at pump onset (p=0.001), taking more daily boluses (7.64 ± 3.33 vs. 6.40 ± 3.18 p=0.003) and measuring more SMBGs per day at follow-up (6.88 ± 2.35 vs. 6.31 ± 2.54 p=0.03). The incidence of severe hypoglycemia decreased from 14.3 to 3.3 events per 100 person years (p<0.0001). Twenty percent did not respond despite a good adherence toward CSII therapy.
  
  
  CONCLUSIONS
  Age <6 years, high or low HbA1c at pump initiation and number of daily boluses were associated with improved or sustained near-normal metabolic outcome. The incidence of severe hypoglycemia was significantly reduced. Twenty percent of the population had good adherence without any metabolic improvement.
authors.affiliation: The Pediatric Department at Copenhagen University Hospital, Herlev, Denmark. Electronic address: ida.m.overgaard@gmail.com.
authors.forename: I
authors.initials: I
authors.lastname: Overgaard Ingeholm
authors.affiliation: The Pediatric Department at Copenhagen University Hospital, Herlev, Denmark; Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark.
authors.forename: J
authors.initials: J
authors.lastname: Svensson
authors.affiliation: The Pediatric Department at Copenhagen University Hospital, Herlev, Denmark.
authors.forename: B
authors.initials: B
authors.lastname: Olsen
authors.affiliation: The Pediatric Department at Hillerød Hospital, Hillerød, Denmark.
authors.forename: L
authors.initials: L
authors.lastname: Lyngsøe
authors.affiliation: The Pediatric Department at Kolding Hospital, Kolding, Denmark.
authors.forename: J
authors.initials: J
authors.lastname: Thomsen
authors.affiliation: The Pediatric Department at Copenhagen University Hospital, Herlev, Denmark; Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark. Electronic address: jesper.johannesen@regionh.dk.
authors.forename: J
authors.initials: J
authors.lastname: Johannesen
mesh_terms: D000293:Adolescent; D015190:Blood Glucose Self-Monitoring; D002648:Child; D003718:Denmark / Q000453:epidemiology; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D015994:Incidence; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems; D008297:Male; D011446:Prospective Studies
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Boluses; CSII; Children and adolescents; Hypoglycemia; Self monitored blood glucoses