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Insulin pumps in pediatric routine care improve long‐term metabolic control without increasing the risk of hypoglycemia
Author(s) -
Hanas Ragnar,
Adolfsson Peter
Publication year - 2006
Publication title -
pediatric diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.678
H-Index - 75
eISSN - 1399-5448
pISSN - 1399-543X
DOI - 10.1111/j.1399-543x.2006.00145.x
Subject(s) - medicine , insulin pump , hypoglycemia , incidence (geometry) , type 1 diabetes , insulin , diabetes mellitus , population , pediatrics , infusion pump , metabolic control analysis , unconsciousness , diabetic ketoacidosis , anesthesia , endocrinology , physics , environmental health , optics
Although continuous subcutaneous insulin infusion (CSII) has been used in pediatric practice for >20 yr, the technique is not widely used in many countries. The aim of this non‐randomized population‐based study was to evaluate CSII in routine pediatric care. In a 1‐yr cross‐sectional evaluation, 27/89 patients (30.3%, age 7–21 yr) used pumps (two during the night only), the others 4–6 injections/day. In patients with >2 yr of diabetes, pump users had higher HbA1c (8.9 ± 1.0 vs. 8.2 ± 1.6%, p = 0.04), less insulin/24 h (0.9 ± 0.1 vs. 1.0 ± 0.2 U/kg, p = 0.002), and longer diabetes duration (p = 0.02). The higher HbA1c is explained by 67% of pump patients having high HbA1c (>8.5%) as the major indication for CSII. The overall incidence of severe hypoglycemia was 31.5/100 patient years, 40.3 for injection therapy, and 11.1 for pump therapy (p = not significant). The incidence of severe hypoglycemia with unconsciousness was 12.9/100 patient years and with seizures 9.7 for injection therapy, whereas no children on pumps experienced these complications during the cross‐sectional study year. We had no admissions for ketoacidosis in either group during this year. The pump patients were followed for 5 yr after pump start. Two stopped using the pump after 2 and 3 yr. For the patients with high HbA1c as indication, mean HbA1c the year before pump was 9.5%. Mean HbA1c during the first year with pump was lowered to 8.9% (p = 0.019), the second year 8.6% (p = 0.017), the third year 8.6 (p = 0.012), the fourth year 8.7 (p = 0.062), and the fifth year 8.9% (p = 0.28). We found six cases of ketoacidosis corresponding to 4.7/100 patient years. In conclusion, we found a long‐term lowering of HbA1c after starting CSII in a pediatric population, decreased frequency of severe hypoglycemia, and a low risk of ketoacidosis.