title: Use of insulin pump therapy in children and adolescents with type 1 diabetes and its impact on metabolic control: comparison of results from three large, transatlantic paediatric registries.
abstract: OBJECTIVE
  While the use of insulin pumps in paediatrics has expanded dramatically, there is still considerable variability among countries in the use of pump technology. The present study sought to describe differences in metabolic control and pump use in young people with type 1 diabetes using data collected in three multicentre registries.
  
  
  METHODS
  Data for the years 2011 and 2012 from 54,410 children and adolescents were collected from the Prospective Diabetes Follow-up Registry (DPV; n = 26,198), T1D Exchange (T1DX; n = 13,755) and the National Paediatric Diabetes Audit (NPDA; n = 14,457). The modality of insulin delivery, based on age, sex and ethnic minority status, and the impact of pump use on HbA1c levels were compared.
  
  
  RESULTS
  The overall mean HbA1c level was higher in the NPDA (8.9 ± 1.6% [74 ± 17.5 mmol/mol]) than in the DPV (8.0 ± 1.6% [64 ± 17.0 mmol/mol], p < 0.001) and T1DX (8.3 ± 1.4% [68 ± 15.4 mmol/mol], p < 0.001). Conversely, pump use was much lower in the NPDA (14%) than in the DPV (41%, p < 0.001) and T1DX (47%, p < 0.001). In a pooled analysis, pump use was associated with a lower mean HbA1c (pump: 8.0 ± 1.2% [64 ± 13.3 mmol/mol] vs injection: 8.5 ± 1.7% [69 ± 18.7 mmol/mol], p < 0.001). In all three registries, those with an ethnic minority status were less likely to be treated with a pump (p < 0.001) and boys were treated with a pump less often compared with girls (p < 0.001).
  
  
  CONCLUSIONS
  Despite similar clinical characteristics and proportion of minority participants, substantial differences in metabolic control exist across the three large transatlantic registries of paediatric patients with type 1 diabetes, which appears to be due in part to the frequency of insulin pump therapy.
authors.affiliation: Pediatric Endocrinology, Children's Diabetes Program, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Sherr
authors.affiliation: ZIBMT, Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany; affiliated with the German Center for Diabetes Research (DZD).
authors.forename: Julia M
authors.initials: JM
authors.lastname: Hermann
authors.affiliation: General Paediatrics and Diabetes, Leeds Children's Hospital, Leeds, UK.
authors.forename: Fiona
authors.initials: F
authors.lastname: Campbell
authors.affiliation: Jaeb Center for Health Research, 15310 Amberly Drive, Suite 350, Tampa, FL, 33647, USA. t1DStats@jaeb.org.
authors.forename: Nicole C
authors.initials: NC
authors.lastname: Foster
authors.affiliation: Department of Paediatrics, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: Sabine E
authors.initials: SE
authors.lastname: Hofer
authors.affiliation: Department of Paediatric Endocrinology and Diabetes, Royal London Children's Hospital, Barts Health NHS Trust, London, UK.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Allgrove
authors.affiliation: Barbara Davis Center for Childhood Diabetes, Aurora, CO, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Maahs
authors.affiliation: Department of Endocrinology and Diabetology, University of Leipzig, Hospital for Children and Adolescents, Leipzig, Germany.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Kapellen
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
authors.forename: Naomi
authors.initials: N
authors.lastname: Holman
authors.affiliation: Pediatric Endocrinology, Children's Diabetes Program, Yale School of Medicine, New Haven, CT, USA.
authors.forename: William V
authors.initials: WV
authors.lastname: Tamborlane
authors.affiliation: ZIBMT, Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany; affiliated with the German Center for Diabetes Research (DZD).
authors.forename: Reinhard W
authors.initials: RW
authors.lastname: Holl
authors.affiliation: Jaeb Center for Health Research, 15310 Amberly Drive, Suite 350, Tampa, FL, 33647, USA.
authors.forename: Roy W
authors.initials: RW
authors.lastname: Beck
authors.affiliation: Paediatric Endocrinology and Diabetes, Children's Hospital for Wales, Cardiff, UK.
authors.forename: Justin T
authors.initials: JT
authors.lastname: Warner
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000032:analysis; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000628:therapy*; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use*; D007332:Insulin Infusion Systems; D008297:Male; D015337:Multicenter Studies as Topic; D010372:Pediatrics / Q000379:methods*; D011446:Prospective Studies; D012042:Registries
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin
keywords: Clinical outcomes; Continuous subcutaneous insulin infusion; DPV; Insulin pumps; National Paediatric Diabetes Audit; T1D Exchange clinic registry; Treatment modalities; Type 1 diabetes