Continuous Subcutaneous Insulin Infusion Therapy for Children and Adolescents: An Option for Routine Diabetes Care

Abstract

Objective. The purpose of this study was to determine the feasibility of continuous subcutaneous insulin infusion (CSII) (insulin pump) therapy in routine pediatric diabetes care by comparing the HbA1c, body mass index (BMI), and hypoglycemic episodes before and after initiation of CSII therapy. Research Design and Methods. Data from 56 patients (7–23 years old) were collected during regularly scheduled visits at a frequency similar to non-CSII patients. Results. The data were analyzed for the entire cohort and 3 subgroups (decreased, stable, or increased HbA1c) stratified according to a ≥0.5% change in HbA1c. The total cohort demonstrated a decrease in HbA1c from 8.5% to 8.3%. The decreased cohort (39.4% of the total cohort) demonstrated a significant decrease in HbA1c from 8.6% to 7.6%. The mean HbA1c of the stable cohort (41.0%) was 8.7%. The increased cohort (19.6%) had an increase in HbA1c from 7.8% to 8.8%. Thirty-six patients (64.3%) maintained or achieved a HbA1c <8.0% or achieved a HbA1c at least 1% lower than their pre-CSII level. Of concern, 6 patients (10.7%) demonstrated a clinically significant increase in HbA1c from 8.3% to 9.6%. For the entire cohort, the rate of severe hypoglycemia before and on CSII therapy was 12.3 and 9.5 events per 100 patient-years, respectively. A statistically significant proportion of patients reported a decrease in seizure frequency versus an increase (17.9% vs 1.8%) as well as a decrease in overall hypoglycemic frequency versus an increase (41.1% vs 17.9%). There was not a clinically significant increase in BMI, even in the decreased HbA1c cohort. Conclusions. CSII therapy is an appropriate option for some children in routine pediatric diabetes care. It can effectively decrease the HbA1c and reduce hypoglycemic episodes, without producing an abnormal increase in BMI.