Benefits of continuous subcutaneous insulin infusion in children with type 1 diabetes☆

Abstract 

Objective

To examine the effect of continuous subcutaneous insulin infusion (CSII) therapy on parameters affecting long-term outcome in type 1 diabetes.

Study design

Height, weight, body mass index, insulin dose, glycosylated hemoglobin (HbA_1C), and blood glucose data from home meter downloads were collected prospectively for analysis in 51 children (age, 10.7±3.1 years, mean±SD) throughout the 12 months before and after introducing CSII.

Results

Before pump initiation, HbA_1C was relatively stable, but it fell to 7.7±0.2% (P<.001) within 3 months of CSII and remained decreased (7.9±0.1%) at 12 months (P<.01). In contrast, weight standard deviation score increased before CSII (from 0.50±0.13 to 0.60±0.13, P<.05), but remained unchanged (0.61±0.11) in the year thereafter. Although severe hypoglycemia (<50 mg/dL) was reduced in the entire cohort, HbA_1C improved primarily in young children and teenagers. Comparison of glycemic responders (HbA_1C <7.5, or a decrease >1% on CSII, n=23) with nonresponders demonstrated no differences with respect to gender, socioeconomic status, weight standard deviation score, body mass index, initial HbA_1C, frequency of hypoglycemia, or number of education visits before CSII.

Conclusion

Continuous subcutaneous insulin infusion is effective in lowering HbA_1C and the occurrence of severe nocturnal hypoglycemia without excessive weight gain in most children with type 1 diabetes. HbA_1C response to CSII is poorer in preadolescents than in young children or teenagers.

Abbreviations:  CSII, Continuous subcutaneous insulin infusion, HbA_1C, Glycosylated hemoglobin, SDS, Standard deviation score, TDD, Total daily dose