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Does treatment with an insulin pump improve glycaemic control in children and adolescents with type 1 diabetes? A retrospective case–control study
Author(s) -
Brorsson Anna Lena,
Viklund Gunnel,
Örtqvist Eva,
Lindholm Olinder Anna
Publication year - 2015
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/pedi.12209
Subject(s) - medicine , ketoacidosis , diabetic ketoacidosis , type 1 diabetes , glycated hemoglobin , pediatrics , incidence (geometry) , insulin , body mass index , retrospective cohort study , insulin pump , diabetes mellitus , metabolic control analysis , type 2 diabetes , endocrinology , physics , optics
Objective To investigate long‐term effects on glycaemic control, ketoacidosis, serious hypoglycaemic events, insulin requirements, and body mass index standard deviation scores ( BMI‐SDS ) in children and adolescents with type 1 diabetes starting on continuous subcutaneous insulin infusion ( CSII ) compared with children and adolescents treated with multiple daily injections ( MDI ). Methods This retrospective case–control study compares 216 patients starting CSII with a control group on MDI (n = 215), matched for glycated hemoglobin ( HbA1c ), sex, and age during a 2‐yr period. Variables collected were gender, age, HbA1c , insulin requirement, BMI , BMI‐SDS , ketoacidosis, and serious hypoglycaemic events. Results In the CSII group there was an improvement in HbA1c after 6 and 12 months compared with the MDI group. For boys and girls separately the same effect was detected after 6 months, but only for boys after 12 months. The incidence of ketoacidosis was higher in the CSII group compared with the MDI group (2.8 vs. 0.5/100 person‐yr). The incidences of severe hypoglycaemic episodes per 100 person‐yr were three in the CSII group and six in the MDI group (p < 0.05). After 6, 12, and 24 months, the insulin requirement was higher in the MDI group. Conclusions This study shows that treatment with CSII resulted in an improvement in HbA1c levels up to 1 yr and decreased the number of severe hypoglycaemic events, but the frequency of ketoacidosis increased. The major challenge is to identify methods to maintain the HbA1c improvement, especially among older children and teenagers, and reduce the frequency of ketoacidosis.