title: Impact of insulin pump therapy on long-term glycemic control in a pediatric Spanish cohort.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of Continuous Subcutaneous Insulin Infusion (CSII) in a pediatric cohort and to determine if the ISPAD/IDF/ADA criteria for good metabolic control are achieved during long periods of time.
  
  
  METHODS
  Retrospective longitudinal study including ninety patients [10.5 (6.5-13.9) years of age, 58% males]. Age at debut, type 1 diabetes mellitus duration, pubertal stage, HbA1c, insulin dose, mean number of glycemic controls, number of basal rates, % basal/total insulin, severe hypoglycemia and diabetic ketoacidosis events were analyzed. Subgroup analysis based on age and pubertal stage was performed.
  
  
  RESULTS
  HbA1c decreased from 6.9% [52 mmol/mol] to 6.7% [50 mmol/mol] after one year of CSII. Afterwards, it remained less than 7% during the follow-up period (median 3.5 ± 1.8 years (range 1-8). Prior to CSII, 76% of the subjects met ISPAD/ADA criteria. One year after initiating CSII, 96% of children had HbA1c<7.5%. Improvement in glycohemoglobin levels was most prominent in those patients with the highest HbA1c initial levels. Total insulin dose decreased from 0.89 to 0.73 UI/kg/day (p<0.001). Proportion of basal/total insulin changed significantly (47 to 42% (p<0.05)). Number of fractions of the basal rate increased from 5.6 ± 1.8 at one year of CSII to 6.7 ± 2.1 five years later. Incidence of severe hypoglycemic events decreased from 19 to 6.9 episodes/100 patient-year. Only 2 episodes of diabetic ketoacidosis occurred.
  
  
  CONCLUSIONS
  CSII allows reaching ISPAD/IDF/ADA goals safely during an extended follow-up period in a diabetic pediatric cohort.
authors.affiliation: Pediatric Diabetes Unit, Ramón y Cajal Hospital, Alcalá University, Crta Colmenar km 9,100, 28034 Madrid, Spain. Electronic address: esmcol@yahoo.es.
authors.forename: Esmeralda
authors.initials: E
authors.lastname: Colino
authors.affiliation: Pediatric Diabetes Unit, Ramón y Cajal Hospital, Alcalá University, Crta Colmenar km 9,100, 28034 Madrid, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Martín-Frías
authors.affiliation: Pediatric Diabetes Unit, Ramón y Cajal Hospital, Alcalá University, Crta Colmenar km 9,100, 28034 Madrid, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Yelmo
authors.affiliation: Pediatric Diabetes Unit, Ramón y Cajal Hospital, Alcalá University, Crta Colmenar km 9,100, 28034 Madrid, Spain.
authors.forename: M Ángeles
authors.initials: MÁ
authors.lastname: Álvarez
authors.affiliation: Pediatric Diabetes Unit, Ramón y Cajal Hospital, Alcalá University, Crta Colmenar km 9,100, 28034 Madrid, Spain.
authors.forename: Belén
authors.initials: B
authors.lastname: Roldán
authors.affiliation: Pediatric Diabetes Unit, Ramón y Cajal Hospital, Alcalá University, Crta Colmenar km 9,100, 28034 Madrid, Spain. Electronic address: raquel.barrio@salud.madrid.org.
authors.forename: Raquel
authors.initials: R
authors.lastname: Barrio
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D016883:Diabetic Ketoacidosis / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D015994:Incidence; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008297:Male; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Continuous subcutaneous insulin infusion; Glycemic control; ISPAD/IDF HbA1c recommendations; Pediatric age