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Insulin pump therapy in type 1 pediatric patients: now and into the year 2000
F R Kaufman1, M Halvorson, D Miller
1Division of Endocrinology and Metabolism, Childrens Hospital, Los Angeles, and Department of Pediatrics, University of Southern California School of Medicine, Los Angeles, California, USA. fkaufman@chlais.usc.edu
Insights
Continuous subcutaneous insulin infusion (CSII) improves glycemic control and quality of life in pediatric patients with diabetes. Pump therapy offers benefits for conditions like diabetic ketoacidosis (DKA) but requires careful education and management.
Area of Science:
- Pediatric Endocrinology
- Metabolic Disorders
- Diabetes Management
Background:
- Continuous subcutaneous insulin infusion (CSII) offers meticulous glycemic control for various medical conditions.
- Insulin pump therapy can ameliorate severe hypoglycemia, dawn phenomenon, diabetic ketoacidosis (DKA), and hypoglycemia unawareness.
- However, CSII presents challenges including weight gain, ketosis, infections, and hypoglycemia risk, particularly in young children.
Purpose of the Study:
- To evaluate the effectiveness and safety of CSII in pediatric patients with diabetes.
- To assess the impact of CSII on glycemic control, quality of life, and diabetes-related complications.
- To explore modified CSII approaches for young children and those with recurrent DKA.
Main Methods:
- Utilized CSII in a pediatric patient population (mean age 13.6+/-3.9 years), including nighttime-only use for younger children (7-10 years) and patients with recurrent DKA.
- Provided comprehensive pump education tailored to pediatric patients and their families, covering basal/bolus dosing, and management of exercise, food, and illness.
- Monitored outcomes including glycemic control (HbA1c), complication rates (hypoglycemia, DKA), quality of life, knowledge, adherence, and responsibility.
Main Results:
- CSII led to significant improvements in quality of life, knowledge, adherence, and responsibility among pediatric patients.
- Associated with a reduction in hypoglycemia, DKA rates, and mean HbA1c.
- Nighttime-only CSII allowed young children to benefit from improved nocturnal glycemia without risks when unsupervised.
Conclusions:
- CSII is an effective therapy for improving glycemic control and outcomes in pediatric diabetes management.
- Tailored education and modified pump strategies (e.g., nighttime-only) enhance CSII benefits and safety in children.
- Advancements in pump technology and continuous glucose monitoring pave the way for an artificial pancreas.
Abstract:
There are a number of medical conditions such as growth failure in children, pregnancy, lipid abnormalities, and early complications that are improved by the meticulous glycemic control that can be achieved with insulin pump therapy (CSII). By using an insulin pump, many patients with severe hypoglycemia, the dawn phenomenon, extremes of glycemic excursion, recurrent diabetic ketoacidosis (DKA) and hypoglycemia unawareness have amelioration of these problems. However, pump therapy involves problems such as weight gain, recurrent ketosis due to pump failure, infections, and risk of hypoglycemia. Owing to many developmental issues, young children may not be able to wear the pump without parental supervision. We have used the pump at night time only in these patients. This has allowed children of 7-10 years of age to benefit from improved nocturnal glycemia without the risk of pump therapy when they are without an adult to help. We have also used the pump in subjects with recurrent DKA and in our general patient population (mean age 13.6+/-3.9 years). In our pump cohort, CSII led to improvement in quality of life, knowledge, adherence, and responsibility. A reduction in hypoglycemia, DKA rate and mean HbA(1c) was associated with pump usage. For this to occur, however, pump education must be geared to the pediatric subject and his/her family. Education materials and tools help in learning how to use the pump and how to deal with the intricacies of basal and bolus dosing, and the effect of exercise, food and illness on diabetes management. The pump has improved since it was first introduced and these modifications have made it easier, more painless and less hazardous. With the development of continuous glucose sensors and implantable pumps, the next century will see pump therapy lead to the artificial pancreas.