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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.
Pediatr Diabetes. 2015 Nov; 16(7):546-53.PD

Abstract

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.

Authors+Show Affiliations

Department of Women's and Children's Health, Karolinska Institute and Hospital, Stockholm, Sweden.Department of Women's and Children's Health, Karolinska Institute and Hospital, Stockholm, Sweden.Department of Women's and Children's Health, Karolinska Institute and Hospital, Stockholm, Sweden.Department of Medical Sciences, Uppsala University, Uppsala, Sweden. Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25327782

Citation

Brorsson, Anna Lena, et al. "Does Treatment With an Insulin Pump Improve Glycaemic Control in Children and Adolescents With Type 1 Diabetes? a Retrospective Case-control Study." Pediatric Diabetes, vol. 16, no. 7, 2015, pp. 546-53.
Brorsson AL, Viklund G, Örtqvist E, et al. Does treatment with an insulin pump improve glycaemic control in children and adolescents with type 1 diabetes? A retrospective case-control study. Pediatr Diabetes. 2015;16(7):546-53.
Brorsson, A. L., Viklund, G., Örtqvist, E., & Lindholm Olinder, A. (2015). Does treatment with an insulin pump improve glycaemic control in children and adolescents with type 1 diabetes? A retrospective case-control study. Pediatric Diabetes, 16(7), 546-53. https://doi.org/10.1111/pedi.12209
Brorsson AL, et al. Does Treatment With an Insulin Pump Improve Glycaemic Control in Children and Adolescents With Type 1 Diabetes? a Retrospective Case-control Study. Pediatr Diabetes. 2015;16(7):546-53. PubMed PMID: 25327782.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Does treatment with an insulin pump improve glycaemic control in children and adolescents with type 1 diabetes? A retrospective case-control study. AU - Brorsson,Anna Lena, AU - Viklund,Gunnel, AU - Örtqvist,Eva, AU - Lindholm Olinder,Anna, Y1 - 2014/10/20/ PY - 2014/07/10/received PY - 2014/08/06/revised PY - 2014/08/27/accepted PY - 2014/10/21/entrez PY - 2014/10/21/pubmed PY - 2016/7/21/medline KW - adolescent KW - case-control studies KW - child KW - diabetes mellitus type 1 KW - insulin infusion systems SP - 546 EP - 53 JF - Pediatric diabetes JO - Pediatr Diabetes VL - 16 IS - 7 N2 - 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. SN - 1399-5448 UR - https://www.unboundmedicine.com/medline/citation/25327782/Does_treatment_with_an_insulin_pump_improve_glycaemic_control_in_children_and_adolescents_with_type_1_diabetes_A_retrospective_case_control_study_ L2 - https://doi.org/10.1111/pedi.12209 DB - PRIME DP - Unbound Medicine ER -