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Improved glycemic control after long-term insulin pump use in pediatric patients with type 1 diabetes

Laura Scrimgeour1, Erin Cobry, Kim McFann

  • 1Department of Pediatrics, Barbara Davis Center for Childhood Diabetes, University of Colorado Health Sciences Center, Aurora, CO 80045, USA.

Diabetes Technology & Therapeutics
|October 13, 2007
PubMed

Insights

Continuous subcutaneous insulin infusion (CSII) therapy in children with type 1 diabetes (T1D) lowers HbA1c and severe hypoglycemia (SH) events. However, diabetic ketoacidosis (DKA) episodes increased with long-term CSII use.

Area of Science:

  • Pediatric Endocrinology
  • Metabolic Disorders
  • Diabetes Management

Background:

  • Limited data exists on the long-term efficacy and safety of continuous subcutaneous insulin infusion (CSII) therapy in pediatric populations.
  • Type 1 diabetes (T1D) management in children requires careful consideration of treatment modalities for optimal outcomes.

Purpose of the Study:

  • To evaluate the long-term effects of CSII therapy on glycemic control, body mass index (BMI), and severe hypoglycemia (SH) and diabetic ketoacidosis (DKA) events in youth with T1D.
  • To assess the impact of initiating CSII therapy at different ages (pre-teen vs. teen years) on glycemic control during adolescence.

Main Methods:

  • Retrospective chart review of 291 pediatric patients with T1D treated with CSII for at least one year.
  • Analysis of hemoglobin A1c (HbA1c) levels, BMI z-scores, and incidence of SH and DKA events before and during CSII therapy.

Main Results:

  • Mean HbA1c decreased significantly from baseline (8.7%) to 1 year (8.2%) and remained low (8.3%) long-term.
  • Severe hypoglycemia (SH) events decreased from 9.06 to 7.96 per 100 patient-years, while diabetic ketoacidosis (DKA) episodes increased from 1.39 to 3.98 per 100 patient-years.
  • No significant difference in glycemic control was observed when initiating CSII in pre-teen versus teen years.

Conclusions:

  • Long-term CSII therapy in pediatric patients with T1D is associated with improved glycemic control (lower HbA1c) and reduced SH events.
  • An increased incidence of DKA events was observed during long-term CSII use in this pediatric cohort.
  • The timing of CSII initiation (pre-teen vs. teen) did not confer additional glycemic control benefits during adolescence.
Abstract

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