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Does treatment with an insulin pump improve glycaemic control in children and adolescents with type 1 diabetes? A

Anna Lena Brorsson1, Gunnel Viklund1, Eva Örtqvist1

  • 1Department of Women's and Children's Health, Karolinska Institute and Hospital, Stockholm, Sweden.

Pediatric Diabetes
|October 21, 2014
PubMed

Insights

Continuous subcutaneous insulin infusion (CSII) improved glycemic control and reduced severe hypoglycemia in children with type 1 diabetes. However, CSII also increased ketoacidosis risk, posing a challenge for long-term management.

Area of Science:

  • Pediatric Endocrinology
  • Metabolic Disorders
  • Diabetes Management

Background:

  • Type 1 diabetes (T1D) management in children and adolescents requires optimizing glycemic control while minimizing complications.
  • Continuous subcutaneous insulin infusion (CSII) and multiple daily injections (MDI) are primary treatment modalities.
  • Long-term comparative data on CSII versus MDI in pediatric T1D populations are crucial for informed treatment decisions.

Purpose of the Study:

  • To compare the long-term effects of CSII versus MDI on glycemic control (HbA1c), ketoacidosis, severe hypoglycemia, insulin needs, and BMI-SDS in pediatric T1D patients.
  • To evaluate the efficacy and safety profiles of CSII compared to MDI in a matched cohort of children and adolescents with T1D.

Main Methods:

  • Retrospective case-control study involving 216 T1D patients initiating CSII and 215 matched MDI patients.
  • Matching criteria included glycated hemoglobin (HbA1c), sex, and age over a 2-year period.
  • Key variables analyzed: HbA1c, insulin requirement, BMI-SDS, ketoacidosis incidence, and severe hypoglycemic events.

Main Results:

  • CSII group showed improved HbA1c at 6 and 12 months compared to MDI, particularly in boys at 12 months.
  • Ketoacidosis incidence was higher in the CSII group (2.8/100 person-yr) versus MDI (0.5/100 person-yr).
  • Severe hypoglycemia incidence was lower in the CSII group (3/100 person-yr) compared to MDI (6/100 person-yr). Insulin requirements were higher in the MDI group.

Conclusions:

  • CSII improves HbA1c and reduces severe hypoglycemia in pediatric T1D up to one year but increases ketoacidosis risk.
  • Maintaining glycemic control improvements with CSII, especially in older children, and mitigating ketoacidosis are key challenges.
  • Further research is needed to optimize CSII strategies for sustained glycemic control and reduced complication rates in pediatric T1D.
Abstract

Keywords:
adolescentcase-control studieschilddiabetes mellitus type 1insulin infusion systems

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