Elsevier

The Journal of Pediatrics

Volume 143, Issue 6, December 2003, Pages 796-801
The Journal of Pediatrics

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

https://doi.org/10.1067/S0022-3476(03)00579-1Get rights and content

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 (HbA1C), 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, HbA1C 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, HbA1C improved primarily in young children and teenagers. Comparison of glycemic responders (HbA1C <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 HbA1C, frequency of hypoglycemia, or number of education visits before CSII.

Conclusion

Continuous subcutaneous insulin infusion is effective in lowering HbA1C and the occurrence of severe nocturnal hypoglycemia without excessive weight gain in most children with type 1 diabetes. HbA1C response to CSII is poorer in preadolescents than in young children or teenagers.

Section snippets

Patients

A total of 51 children diagnosed with type 1 diabetes at the Medical University of South Carolina between the ages of 1.2 and 15.5 years (median, 6.6; mean±SD, 7.2±3.4) participated in this study (Table I). Subjects were between the ages of 5 and 16 years on introduction of CSII (mean±SD, 11.2±3.0). To minimize the contribution of the honeymoon period to our results, the duration of diabetes was >1.5 years (mean±SD, 4.0±2.6) or a pattern of increasing insulin requirements was present in all

Results

Figure 1 shows the changes in HbA1C, weight SDS, and insulin dose throughout the study period. In the year before pump initiation, HbA1C was relatively stable (8.5±0.2% vs 8.4±0.2%), but it fell to 7.7±0.2% (P<.001) within 3 months of CSII and remained reduced (7.9±0.1%) at 12 months (P<.01). Subjects were overweight compared with the norm (P<.001) and gained additional weight in the year before CSII (from 0.50±0.13 to 0.60±0.13, P<.05). Despite improvements in blood glucose control, weight SDS

Discussion

The primary goal of this study was to assess the contribution of CSII to a large pediatric population of patients with type 1 diabetes. To eliminate the potential contribution of confounding factors, we included only patients followed for an entire year before and after initiating the pump. Our findings with regard to metabolic control (as assessed by HbA1C and hypoglycemia frequency) are consistent with findings of several smaller pediatric studies5., 7., 11. which have suggested that HbA1C

Acknowledgements

We acknowledge the work of Anne Sadler, RN, FNP, Jennifer Moffitt, RN, FNP, Amanda Bailey, RD, CDE, Dr L. Lyndon Key, Jr, and Dr Karen Loechner, who participated in the clinical care of the patients. We also thank Purvi Shah, Farrah Datko, and Deyi Zheng, MPH, for their assistance with data collection and analysis. We thank the nurses and staff of the Pediatric Endocrinology Division and the General Clinical Research Center at the Medical University of South Carolina, without whom this study

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☆

S.M.W. is the recipient of a Clinical Associate Physician Award (3 MO 1 RR01700-20S2) from the NIH National Center for Research Resources.

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