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Insulin pump therapy, pre‐pump hemoglobin A 1c and metabolic improvement in children with type 1 diabetes at a tertiary Canadian children's hospital
Author(s) -
Botros Sandra,
Islam Nazrul,
Hursh Brenden
Publication year - 2019
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.12834
Subject(s) - medicine , insulin pump , metabolic control analysis , type 1 diabetes , diabetes mellitus , confidence interval , hemoglobin , mole , type 2 diabetes , insulin , confounding , endocrinology , gastroenterology
Background and Objectives Indications for insulin pump therapy (IPT) in children with type 1 diabetes (T1D) are relatively non‐specific and therefore subject to provider discretion. Health professionals' perceptions of which people will have difficulty with IPT, for example, those with higher hemoglobin A 1c (HbA 1c ), may not be correct. This study examined the effect of IPT on HbA 1c , and the role of pre‐pump HbA 1c on this effect. Methods All children with T1D started on IPT at British Columbia Children's Hospital from January 2011 through June 2016 were included if they had HbA 1c values available both before and after IPT (n = 125). Generalized estimating equations was used to estimate the effects of IPT on HbA 1c , stratified by pre‐pump HbA 1c levels (good: <7.5% [<58 mmol/mol], moderate: 7.5%‐9.0% [58‐75 mmol/mol], poor: >9.0% [>75 mmol/mol]). Results After adjusting for potential confounders, mean HbA 1c decreased by 0.48% [5.2 mmol/mol] (95% confidence interval: −0.64, −0.33% [−7.0, −3.6 mmol/mol]; P < 0.0001) after IPT initiation. The adjusted mean HbA 1c decreased by 0.14% [1.5 mmol/mol] (−0.35, 0.07% [−3.8, 0.8 mmol/mol]; P = 0.188), 0.54% [5.9 mmol/mol] (−0.74, −0.34% [−8.1, −3.7 mmol/mol]; P < 0.0001), and 1.08% [11.8 mmol/mol] (−1.69, −0.46% [−18.5, −5.0 mmol/mol]; P = 0.0006) after pump initiation in the good, moderate, and poor pre‐pump metabolic control groups, respectively. Conclusions Pre‐pump HbA 1c appears to play a significant role in the effects of IPT on HbA 1c , with the largest decrease in HbA 1c seen in the poor pre‐pump HbA 1c group. Eligibility and consideration for IPT should be expanded to routinely include these children.