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Indications for insulin pump therapy in different age groups: an analysis of 1,567 children and adolescents.
Diabet Med. 2007 Aug; 24(8):836-42.DM

Abstract

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.

Authors+Show Affiliations

Hospital for Children and Adolescents, University of Leipzig, Germany. kapt@medizin.uni-leipzig.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17650157

Citation

Kapellen, T M., et al. "Indications for Insulin Pump Therapy in Different Age Groups: an Analysis of 1,567 Children and Adolescents." Diabetic Medicine : a Journal of the British Diabetic Association, vol. 24, no. 8, 2007, pp. 836-42.
Kapellen TM, Heidtmann B, Bachmann J, et al. Indications for insulin pump therapy in different age groups: an analysis of 1,567 children and adolescents. Diabet Med. 2007;24(8):836-42.
Kapellen, T. M., Heidtmann, B., Bachmann, J., Ziegler, R., Grabert, M., & Holl, R. W. (2007). Indications for insulin pump therapy in different age groups: an analysis of 1,567 children and adolescents. Diabetic Medicine : a Journal of the British Diabetic Association, 24(8), 836-42.
Kapellen TM, et al. Indications for Insulin Pump Therapy in Different Age Groups: an Analysis of 1,567 Children and Adolescents. Diabet Med. 2007;24(8):836-42. PubMed PMID: 17650157.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Indications for insulin pump therapy in different age groups: an analysis of 1,567 children and adolescents. AU - Kapellen,T M, AU - Heidtmann,B, AU - Bachmann,J, AU - Ziegler,R, AU - Grabert,M, AU - Holl,R W, PY - 2007/7/26/pubmed PY - 2007/11/10/medline PY - 2007/7/26/entrez SP - 836 EP - 42 JF - Diabetic medicine : a journal of the British Diabetic Association JO - Diabet Med VL - 24 IS - 8 N2 - 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. SN - 0742-3071 UR - https://www.unboundmedicine.com/medline/citation/17650157/Indications_for_insulin_pump_therapy_in_different_age_groups:_an_analysis_of_1567_children_and_adolescents_ DB - PRIME DP - Unbound Medicine ER -