[Continuous subcutaneous insulin infusion (CSII) in treating young diabetic patients]

Continuous subcutaneous insulin infusion (CSII) is used in selected type 1 diabetic subjects to achieve strict blood glucose control. A quarter of a century after its introduction, worldwide use of CSII is increasing. Review of controlled trials shows that, in most patients, mean blood glucose concentrations and glycated hemoglobin percentages are either slightly lower or similar on CSII versus multiple insulin injections. However, hypoglycemia is markedly less frequent than during intensive injection therapy. Ketoacidosis occurs at the same rate. Nocturnal glycemic control is improved with insulin pumps, and automatic basal rate changes help to minimize a pre-breakfast blood glucose increase (the "dawn phenomenon") often seen with injection therapy. Patients with "brittle" diabetes characterized by recurrent ketoacidosis are often not improved by CSII, although there may be exceptions. Insulin pump therapy has been shown to be beneficial in pediatric patients with type 1 diabetes. Our experience with insulin pump therapy in young children, has been positive. Our young patients have had a reduction in HbA1c, mean blood glucose levels, and glycemic excursion; a decrease in episodes of severe hypoglycemia; and an increase in family functioning around diabetes. We believe the success of pump program in young patients can be attributed to the fact that we have employed appropriate criteria for patient selection and have a standardized method to initiate pump therapy and to follow and support our patients/ families. Experience with insulin-pump therapy indicates that candidates for CSII must be strongly motivated to improve self-monitoring of blood glucose, they must also understand and demonstrate use of the insulin pump.