Does treatment with an insulin pump improve glycaemic control in children and adolescents with type 1 diabetes? A retrospective case-control study.

Abstract

OBJECTIVE:

To investigate long-term effects on glycaemic control, ketoacidosis, serious hypoglycaemic events, insulin requirements, and body mass index standard deviation scores (BMI-SDS) in children and adolescents with type 1 diabetes starting on continuous subcutaneous insulin infusion (CSII) compared with children and adolescents treated with multiple daily injections (MDI).

METHODS:

This retrospective case-control study compares 216 patients starting CSII with a control group on MDI (n = 215), matched for glycated hemoglobin (HbA1c), sex, and age during a 2-yr period. Variables collected were gender, age, HbA1c, insulin requirement, BMI, BMI-SDS, ketoacidosis, and serious hypoglycaemic events.

RESULTS:

In the CSII group there was an improvement in HbA1c after 6 and 12 months compared with the MDI group. For boys and girls separately the same effect was detected after 6 months, but only for boys after 12 months. The incidence of ketoacidosis was higher in the CSII group compared with the MDI group (2.8 vs. 0.5/100 person-yr). The incidences of severe hypoglycaemic episodes per 100 person-yr were three in the CSII group and six in the MDI group (p < 0.05). After 6, 12, and 24 months, the insulin requirement was higher in the MDI group.

CONCLUSIONS:

This study shows that treatment with CSII resulted in an improvement in HbA1c levels up to 1 yr and decreased the number of severe hypoglycaemic events, but the frequency of ketoacidosis increased. The major challenge is to identify methods to maintain the HbA1c improvement, especially among older children and teenagers, and reduce the frequency of ketoacidosis.

• Authors: Anna Lena Brorsson, Gunnel Viklund, Eva Örtqvist, Anna Lindholm Olinder
• Journal: Pediatric diabetes (Pediatr Diabetes) Vol. 16 Issue 7 Pg. 546-53 (Nov 2015) ISSN: 1399-5448 [Electronic] Denmark
• PMID: 25327782 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Chemical References

• Glycated Hemoglobin A
• Hypoglycemic Agents
• Insulin
• hemoglobin A1c protein, human

Topics

• Adolescent
• Case-Control Studies
• Child
• Cohort Studies
• Diabetes Mellitus, Type 1 (blood, complications, drug therapy)
• Diabetic Ketoacidosis (chemically induced, epidemiology, prevention & control)
• Female
• Follow-Up Studies
• Glycated Hemoglobin (analysis)
• Humans
• Hyperglycemia (epidemiology, prevention & control)
• Hypoglycemia (chemically induced, epidemiology, prevention & control)
• Hypoglycemic Agents (administration & dosage, adverse effects, therapeutic use)
• Incidence
• Insulin (administration & dosage, adverse effects, analogs & derivatives, therapeutic use)
• Insulin Infusion Systems (adverse effects)
• Male
• Patient Education as Topic
• Retrospective Studies
• Sex Characteristics
• Sweden (epidemiology)