Improved Glycemic Control After Long-Term Insulin Pump Use in Pediatric Patients with Type 1 Diabetes

Abstract

Background:

There are currently few data available on the long-term use of continuous subcutaneous insulin infusion (CSII) (insulin pump) therapy in children.

Methods:

Charts from 291 youth with type 1 diabetes (T1D) who were treated with CSII therapy for at least 1 year were reviewed. Data analysis included hemoglobin A_1c(HbA_1c) values, body mass index (BMI) values, and the occurrence of severe hypoglycemia (SH) or diabetic ketoacidosis (DKA) events.

Results:

For the 291 patients, the mean age (±SD) for beginning CSII therapy was 13.3 ± 3.7 years. The mean duration of CSII was 3.7 ± 1.9 years (range 1–9 years). The baseline HbA_1c value was 8.7 ± 1.0%, compared to 8.2 ± 0.9% after 1 year (P < 0.0001). The most recent value for all patients was 8.3 ± 1.3% (P < 0.0001 compared to the baseline values for the same subjects). There was no advantage in glycemic control in the teen years as a result of initiating CSII in the preteen years compared to the teen years. SH events decreased from 9.06 events per 100 patient-years before CSII therapy to 7.96 events per 100 patient-years while on CSII therapy. The incidence of DKA increased from 1.39 events pre-CSII to 3.98 events per 100 patient-years while on CSII therapy. BMI z-scores showed a nonsignificant increase.

Conclusions:

The long-term use of CSII in pediatric patients is beneficial in lowering mean HbA_1c levels and the number of SH events. However, there was an increase in the number of DKA episodes.