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Poor adherence to integral daily tasks limits the efficacy of CSII in youth
Author(s) -
O'Connell MA,
Donath S,
Cameron FJ
Publication year - 2011
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.1399-5448.2010.00740.x
Subject(s) - medicine , glycemic , type 1 diabetes , bolus (digestion) , insulin pump , insulin , pediatrics , cohort , confidence interval , diabetes mellitus , endocrinology
O'Connell MA, Donath S, Cameron FJ. Poor adherence to integral daily tasks limits the efficacy of CSII in youth. Introduction/Aims: Many young people experience improved glycemia with continuous subcutaneous insulin infusion (CSII) regimens; however, sustained glycemic benefit eludes a significant proportion. Our aims were to assess adherence to recommended CSII‐related behaviors in a representative pediatric cohort and to identify potentially modifiable behaviors that impact on HbA1c in youth. Research Design and Methods: Data uploaded from insulin pump devices of 100 youth with type 1 diabetes were analyzed. Results: Ability to translate recommended behaviors into daily self‐management varied widely in youth. Mean bolus frequency was 6.1/d; however, 69/100 entered <4 blood glucose levels (BGL)/d. HbA1c decreased by 0.2% for each additional BGL (p = 0.001) and bolus event (p < 0.001) per day. Prandial insulin omission was common and associated with significantly increased HbA1c. On average, if breakfast insulin was missed ≥4 times per fortnight, HbA1c increased 1.0% (p < 0.001). If one or more days per fortnight with ≤2 food boluses/d were recorded, then HbA1c increased 0.8% (p = 0.001). Increasing age and duration of CSII correlated with poorer adherence to recommended behaviors. Conclusions: Glycemic advantage obtained with CSII regimens is closely related to the manner in which CSII is employed. Poor adherence to integral CSII‐related tasks is frequently encountered in adolescents and limits the efficacy of CSII in these youth.