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Indications for insulin pump therapy in different age groups: an analysis of 1,567 children and adolescents

T M Kapellen1, B Heidtmann, J Bachmann

  • 1Hospital for Children and Adolescents, University of Leipzig, Germany. kapt@medizin.uni-leipzig.de

Diabetic Medicine : a Journal of the British Diabetic Association
|July 26, 2007
PubMed

Insights

Continuous subcutaneous insulin infusion (CSII) is safe for children and adolescents, effectively reducing severe hypoglycemia. This therapy also improves glycemic control, particularly in the first year for those with high HbA1c levels.

Area of Science:

  • Pediatric Endocrinology
  • Metabolic Disorders
  • Diabetes Technology

Background:

  • Continuous subcutaneous insulin infusion (CSII) is a key therapy for managing type 1 diabetes in pediatric patients.
  • Established indications for CSII include managing dawn phenomenon, severe hypoglycemia, hyperglycemia, and improving treatment flexibility.
  • Age-specific differences in the initiation and effectiveness of CSII in children and adolescents require detailed analysis.

Purpose of the Study:

  • To analyze age-specific differences in the indications for initiating CSII in four pediatric age groups.
  • To evaluate the effectiveness of CSII in achieving glycemic goals across different age strata.
  • To assess the safety and impact of CSII on severe hypoglycemia and HbA1c levels in young patients.

Main Methods:

  • Retrospective analysis of 1567 pediatric patients with documented CSII indications from the DPV-database (December 2005).
  • Patients were categorized into four age groups: 0-4 years (A), 5-9 years (B), 10-14 years (C), and 15-19 years (D).
  • Comparison of indications, rates of severe hypoglycemia, and glycated hemoglobin (HbA1c) levels before and after CSII initiation.

Main Results:

  • Common indications for CSII were dawn phenomenon (27.4%), reduction of hypoglycemia (20%), and improvement of hyperglycemia (18.1%), with significant age-related variations (P < 0.0001).
  • Infants and toddlers (group A) most frequently initiated CSII for hypoglycemia reduction (42.5%), while adolescents (groups C & D) cited dawn phenomenon and flexibility.
  • CSII significantly reduced severe hypoglycemia rates (12.1 to 4.49 events/100 patient-years) and lowered HbA1c in patients with high initial levels (8.8% to 8.5% within the first year).

Conclusions:

  • CSII is a safe and effective treatment for children and adolescents with type 1 diabetes.
  • CSII can substantially decrease the incidence of severe hypoglycemia without compromising glycemic control.
  • Significant improvements in HbA1c are achievable within the first year of CSII therapy, especially for patients with previously poor glucose regulation.
Abstract

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