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Outcomes in children managed on continuous subcutaneous insulin infusion therapy: can we trust the figures?
Author(s) -
Makaya Tafadzwa,
Chatterjee Sumana,
Wright Neil P
Publication year - 2012
Publication title -
practical diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.205
H-Index - 24
eISSN - 2047-2900
pISSN - 2047-2897
DOI - 10.1002/pdi.1688
Subject(s) - medicine , diabetes mellitus , glycated haemoglobin , pediatrics , ketoacidosis , body mass index , diabetic ketoacidosis , metabolic control analysis , insulin , type 1 diabetes , type 2 diabetes , endocrinology
With several studies reporting improved glycaemic control with continuous subcutaneous insulin infusion (CSII) therapy, its use over the years has increased. The majority of studies report comparisons of baseline glycated haemoglobin (HbA 1c ) and post‐CSII HbA 1c . Due to the high cost of CSII, many guidelines advocate close monitoring of diabetes control while on CSII, and recommend that CSII is discontinued if there is no sustainable change in glycaemic control. The aims of this study were: to assess outcomes in diabetes control on patients within our specialist diabetes clinic on CSII therapy; and to establish whether there was a difference in outcomes based on whether comparisons were made between measurements from baseline (just before starting CSII) or from 12 months prior to starting CSII. We compared HbA 1c , body mass index standard deviation scores, episodes of diabetic ketoacidosis and severe hypoglycaemia over 24 months – from 12 months before commencing on CSII to 12 months into CSII. While the HbA 1c 12 months after commencing CSII (8.3% [67mmol/mol]) improved significantly from the point CSII was commenced (9.2% [77mmol/mol]; p=0.007), the mean HbA 1c 12 months post‐CSII did not differ significantly from the HbA 1c 12 months pre‐CSII (8.6% [70mmol/mol]) nor from the overall clinic HbA 1c (8.4% [68mmol/mol]). There were no significant changes in the other parameters. In conclusion, comparing baseline HbA 1c levels to post‐CSII HbA 1c readings does not give an accurate assessment of outcome when establishing the role of CSII in diabetes control. We recommend that consideration be given to overall clinic averages, and to HbA 1c readings in the longer interval pre‐CSII. Copyright © 2012 John Wiley & Sons.