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Factors affecting improved glycaemic control in youth using insulin pumps
Author(s) -
Wilkinson J.,
McFann K.,
Chase H. P.
Publication year - 2010
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.1464-5491.2010.03068.x
Subject(s) - medicine , insulin , insulin pump , diabetes mellitus , bolus (digestion) , endocrinology , type 1 diabetes , basal insulin , basal (medicine) , type 2 diabetes
Diabet. Med. 27, 1174–1177 (2010) Abstract Aims The purpose of this study was to evaluate factors associated with insulin pump therapy resulting in lower HbA 1c levels in young people with Type 1 diabetes mellitus. Methods Insulin pumps were downloaded from 150 youth (81 male), ages 5–20 years. Consecutive insulin pump downloads, 3 months apart, were available for 85 (43 male) of the 150 youth and changes in pump use were correlated with changes (≥ 0.5%, ≥ 6 mmol/mol) in HbA 1c levels. Results Using cross‐sectional data, lower HbA 1c values correlated with use of more frequent daily insulin boluses ( r = –0.46, P < 0.0001) and more frequent blood glucose checks/day ( r = –0.35, P < 0.0001). Young people with HbA 1c levels < 7.5% (58 mmol/mol) vs. values of 7.5–9.0% (58‐75 mmol/mol) or ≥ 9.0% (75 mmol/mol) tested blood glucose more frequently/day ( P < 0.0001), bolused more frequently/day ( P < 0.0001), reported more grams of carbohydrates eaten/day ( P < 0.05) and had a higher per cent bolus insulin/day ( P < 0.05) compared with the ≥ 9.0% of youth. Using longitudinal data, 48 of 85 patients had a change in HbA 1c level of ≥ 0.5% (6 mmol/mol) between downloads (24 improved). Increased bolus insulin (OR = 1.15, P = 0.03) and time of temporary basal rate use (OR = 1.017, P = 0.01) predicted ≥ 0.5% (6 mmol/mol) decrease in HbA 1c in logistic regression. Conclusions This study emphasizes the importance of blood glucose testing, of bolus insulin administration and of an increase in the time of temporary basal rate use in relation to improving glycaemic control.