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Factors associated with adherence to continuous subcutaneous insulin infusion in pediatric diabetes

Ghufran S Babar1, Omar Ali, Elaine A Parton

  • 1Children's Hospital of Wisconsin Diabetes Center and Sections of Pediatric Endocrinology & Metabolism and Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.

Diabetes Technology & Therapeutics
|February 17, 2009
PubMed

Insights

Continuous subcutaneous insulin infusion (CSII) is effective for pediatric type 1 diabetes. Pre-initiation screening by a multidisciplinary team predicts adherence, with pubertal status and glycemic control being key factors for successful therapy.

Area of Science:

  • Pediatric Endocrinology
  • Metabolic Disorders
  • Diabetes Management

Background:

  • Continuous subcutaneous insulin infusion (CSII) is a viable treatment for pediatric type 1 diabetes mellitus.
  • Potential risks of CSII include hypoglycemia and diabetic ketoacidosis (DKA).
  • Screening for diabetes management skills is crucial before initiating CSII.

Purpose of the Study:

  • To identify predictors of nonadherence to CSII therapy in pediatric patients.
  • To assess the effectiveness of pre-initiation screening in CSII outcomes.

Main Methods:

  • Retrospective analysis of clinical data from CSII initiations (July 1999-June 2003).
  • Data collected included BMI, HbA1c, insulin dosage, hypoglycemia, SMBG, lipohypertrophy, DKA, and pubertal status.
  • Analysis focused on predictors of CSII discontinuation.

Main Results:

  • Of 46 patients, 85% remained on CSII. Prepubertal patients had zero discontinuation rates, while 22.6% of pubertal patients discontinued.
  • Rising HbA1c at 12 months predicted nonadherence. At 24 months, higher fasting SMBG and severe lipohypertrophy were noted in the discontinuation group.
  • All seven patients who discontinued CSII were pubertal.

Conclusions:

  • Multidisciplinary team screening before CSII initiation leads to lower discontinuation rates.
  • This screening approach improves the likelihood of achieving optimal glycemic control (HbA1c < 8%).
  • Pubertal status is a significant factor in CSII adherence.
Abstract

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