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Indications for insulin pump therapy in different age groups—an analysis of 1567 children and adolescents
Author(s) -
Kapellen T. M.,
Heidtmann B.,
Bachmann J.,
Ziegler R.,
Grabert M.,
Holl R. W.
Publication year - 2007
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/j.1464-5491.2007.02224.x
Subject(s) - medicine , pediatrics , insulin pump , diabetes mellitus , insulin , type 1 diabetes , surgery , endocrinology
Aims The German working group for pump therapy in paediatric patients has defined seven indications for continuous subcutaneous insulin infusion (CSII): dawn phenomenon, reduction of severe hypoglycaemia, improvement of hyperglycaemia, more flexibility, motivation, failure of injection therapy and pregnancy. In this study we analysed age‐specific differences for starting CSII in four age groups (group A: 0–4 years; group B: 5–9 years; group C: 10–14 years; group D: 15–19 years). We also investigated whether glycaemic goals could be reached. Methods A total of 1567 children and adolescents (mean age 12.4 years, mean diabetes duration 5.2 years) with documented indications for CSII from the DPV‐database (December 2005) were included. Results Dawn phenomenon (27.4%), reduction of hypoglycaemia (20%) and improvement of hyperglycaemia (18.1%) were the commonest indications for starting CSII. Indications differed by age group ( P < 0.0001). In infants and toddlers (group A, n = 138) reduction of hypoglycaemia (42.5%) was the commonest indication. For adolescents (group C, n = 789/group D, n = 408) dawn phenomenon (32.1/21.7%) and flexibility (21.7/25.8%) were the main indications. The rate of severe hypoglycaemia with coma in patients commencing CSII in order to reduce hypoglycaemia fell (12.1/100 patient years before CSII vs. 5.8 after 1 year, 4.49 at study end). Glycated haemoglobin (HbA 1c ) in patients with the treatment goal ‘improvement of hyperglycaemia’ was lowered significantly in the first year of CSII (HbA 1c start: 8.8%; after 1 year: 8.5%, P < 0.01) and was stable thereafter (8.8% after 36 months). Conclusions CSII in children and adolescents is safe and can reduce the rate of severe hypoglycaemia without deterioration in glycaemic control. In patients with poor glucose control, a significant reduction in HbA 1c can be achieved in the first year.