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Continuous subcutaneous insulin infusion in children
Insights
Continuous subcutaneous insulin infusion (CSII) shows promise for managing diabetes in children, particularly toddlers, but patient selection is key for adolescents. Further research is needed to confirm its effectiveness and guide optimal use in pediatric diabetes care.
Area of Science:
- Pediatric Endocrinology
- Metabolic Disorders
- Diabetes Management
Background:
- Insulin-dependent diabetes mellitus (IDDM) typically emerges in childhood, necessitating metabolic control to prevent complications.
- Persisting metabolic derangements in children with diabetes are linked to micro- and macrovascular complications.
- Continuous subcutaneous insulin infusion (CSII) is an established method for optimizing diabetes control in adults.
Purpose of the Study:
- To evaluate the efficacy and acceptability of CSII in pediatric diabetes management.
- To explore the potential of CSII as a therapeutic option for diabetic toddlers.
- To identify factors influencing the success of CSII in adolescents with diabetes.
Main Methods:
- Review of existing studies on CSII use in adolescents and toddlers with diabetes.
- Analysis of reported outcomes regarding metabolic control and patient acceptability.
- Discussion of patient selection criteria and organizational requirements for CSII implementation.
Main Results:
- Contradictory findings exist regarding CSII's acceptability and metabolic control in adolescents.
- Some studies report near normalization of blood glucose, while others show only temporary improvements in adolescents.
- Diabetic toddlers show good acceptability and improved metabolic control with CSII, though more research is needed.
Conclusions:
- Patient selection is critical for successful CSII outcomes in adolescents.
- CSII may be a preferred therapy for diabetic toddlers, warranting further investigation.
- High standards of clinic organization, home monitoring, education, and support are essential for effective CSII management in children.
Abstract:
Insulin-dependent diabetes mellitus usually presents in childhood. Since it i is generally accepted that persisting metabolic derangements contribute to the development of micro- and macrovascular complications, a primary aim of the management of children with diabetes is to achieve near normalization of metabolism. In adults continuous subcutaneous insulin infusion (CSII) has been used to optimize control. Despite a reluctance amongst paediatricians to use CSII in children, several studies with pumps have been performed in adolescents. The results of these studies are contradictory with respect to acceptability and achieved metabolic control. Thus, some authors report a near normalization of blood glucose concentrations, whereas others only find a temporary improvement. Patient selection seems to account for many of these differences. This suggests that methods ought to be developed to predict success or failure of CSII in a particular adolescent patient. For diabetic toddlers with their age-specific problems CSII may be a therapy of choice. So far, good acceptability and improved metabolic control are reported in this group. More studies are needed to confirm this. It is important that the diabetic clinic as well as the patient is organized to high standard before starting CSII. Home blood glucose measurements, education, and a 24-h telephone service are essential factors for the management of diabetic children, treated conventionally or with CSII.