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Benefits of continuous subcutaneous insulin infusion (CSII) therapy in preschool children

Y Levy-Shraga1, L Lerner-Geva, D Modan-Moses

  • 1Pediatric Endocrine and Diabetes Unit, Safra Children's Hospital, Sheba Medical Center, Israel. yael.levy.shraga@gmail.com

Experimental and Clinical Endocrinology & Diabetes : Official Journal, German Society of Endocrinology [And] German Diabetes Association
|January 19, 2013
PubMed

Insights

Continuous subcutaneous insulin infusion (CSII) improves metabolic control in preschool children with type 1 diabetes mellitus (T1DM) compared to multiple daily injections (MDI). This therapy is safe and effective for young children with T1DM.

Area of Science:

  • Pediatric Endocrinology
  • Metabolic Disorders
  • Diabetes Management

Background:

  • Type 1 diabetes mellitus (T1DM) incidence is rising in young children.
  • Early diagnosis and intervention are crucial for managing T1DM in this age group.
  • Current treatment options for T1DM in preschoolers include multiple daily injections (MDI) and continuous subcutaneous insulin infusion (CSII).

Purpose of the Study:

  • To evaluate the effectiveness and safety of CSII therapy in preschool children diagnosed with T1DM.
  • To compare metabolic control and adverse events between CSII and MDI in young children with T1DM.
  • To assess the long-term outcomes of initiating CSII therapy before or after age 6.

Main Methods:

  • Retrospective chart review of 113 children diagnosed with T1DM before age 6.
  • Patients categorized into three groups: early CSII initiation (before age 6), MDI throughout, and later CSII initiation (after age 6).
  • Metabolic control assessed by HbA1C levels; safety evaluated by severe hypoglycemia and diabetic ketoacidosis (DKA) rates.

Main Results:

  • Children initiating CSII before age 6 (Group 1) showed sustained lower HbA1C levels compared to those on MDI (Group 2).
  • Group 1 demonstrated improved glycemic control post-CSII initiation, with HbA1C levels ranging from 7.4-8.0%.
  • Initiating CSII after age 6 (Group 3) led to a decrease in HbA1C but remained higher than in the early CSII group.

Conclusions:

  • CSII therapy offers superior metabolic control for preschool children with T1DM compared to MDI.
  • The benefits of early CSII initiation in T1DM management are sustained for at least 5 years.
  • CSII therapy in young children with T1DM is not associated with an increased risk of severe hypoglycemia or DKA events.
Abstract

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