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A decade of insulin pump therapy in a Belgian paediatric diabetes centre: longitudinal outcomes and evolving

Messaaoui Anissa1, Hajselova Lucia1, Tenoutasse Sylvie1

  • 1Department of Pediatric Endocrinology, Diabetology, Metabolic and Nutritional Diseases, Hôpital Universitaire des Enfants Reine Fabiola, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles, Brussels, Belgium.

Acta Clinica Belgica
|June 3, 2026
PubMed

Insights

Continuous subcutaneous insulin infusion (CSII) use in children with type 1 diabetes (T1D) has grown, with a shift to hybrid closed-loop systems. Early initiation and support are key for successful long-term management.

Area of Science:

  • Endocrinology
  • Paediatric Diabetes Care

Background:

  • Continuous subcutaneous insulin infusion (CSII) is a standard treatment for paediatric type 1 diabetes (T1D).
  • Evaluating long-term trends in CSII is crucial for optimizing care.

Purpose of the Study:

  • To assess 11-year trends in CSII adoption, device evolution, and outcomes in paediatric T1D.
  • To identify factors influencing CSII initiation, discontinuation, and switching.

Main Methods:

  • Retrospective cohort study of paediatric T1D patients from 2013-2024.
  • Analysis of CSII adoption rates, device types (standalone vs. hybrid closed-loop), reasons for initiation/discontinuation, and metabolic outcomes (HbA1c, complications).
  • Cox regression used to analyze time to pump discontinuation.

Main Results:

  • CSII adoption rose to 41% by 2024, with a significant shift from standalone pumps to hybrid closed-loop systems (54%).
  • Early initiation (within 1 week of diagnosis) was common (36%). Primary reasons for initiation included lifestyle (51%) and avoiding injections (21%).
  • Modest HbA1c improvement was observed; discontinuation occurred in 11% (mainly patient-driven) and 37% (physician-driven for non-compliance). Older age at initiation predicted discontinuation.

Conclusions:

  • Paediatric CSII adoption and use of advanced systems like hybrid closed-loop have significantly increased.
  • Early CSII initiation is safe and feasible, with stable metabolic outcomes.
  • Multidisciplinary support, education, and adherence monitoring are vital for successful long-term CSII therapy in children with T1D.
Abstract

Keywords:
Type 1 diabetesinsulin pumppaediatricsreal-life data

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