A mixed meal effectively elevates postprandial glycemia after 4-6 h. Dual-wave insulin bolus, in which insulin is calculated for both the carbohydrates and fat proteins, is effective in controlling postprandial glycemia.

Original ArticleContinuous subcutaneous insulin infusion vs. multiple daily injections in children with type 1 diabetes: a systematic review and meta-analysis of randomized control trialsPań kowska E, B1azik M, Dziechciarz P, Szypowska A, Szajewska H. Continuous subcutaneous insulin infusion vs. multiple daily injections in children with type 1 diabetes: a systematic review and meta-analysis of randomized control trials. Pediatric Diabetes 2009: 10: 52-58.Objective: To investigate potential effects of continuous subcutaneous insulin infusion (CSII) compared with multiple daily injections (MDI) on glycemic control in children with type 1 diabetes mellitus (T1DM). Study design: Meta-analysis and systematic review of randomized control studies (RCTs). The electronic databases MEDLINE, Cochrane Library, and EMBASE were searched through October 2007. Results: Six RCTs involving 165 participants with T1DM met our predefined inclusion criteria. Combined data from all trials showed that the CSII group compared with the MDI group experienced a significant reduction in the level of glycosylated hemoglobin. The pooled weighted mean difference (WMD) was 20.24% [95% confidence interval (95% CI) 20.41 to 20.07, p , 0.001] with a fixed model and remained significant in the random effect model. This effect was reached by slightly decreasing insulin requirement [three RCTs, n ¼ 74, WMD 20.22 IU/kg/d (95% CI 20.31 to 20.14, p , 0.001)]. No differences in the incidences of ketoacidosis and severe hypoglycemic events were found. Conclusions: In short-term insulin therapy, CSII compared with MDI is a more effective form of metabolic control and allows reducing the daily insulin requirement. Yet, no conclusions have been made so far whether this effect holds in later years. These results should be approached with caution because of the methodological limitations of the analyzed studies.

Aims/hypothesis The value of managing children with type 1 diabetes using a combination of insulin pump and continuous glucose monitoring starting from diagnosis for improving subsequent glycaemic control and preserving residual beta cell function was determined. Methods A total of 160 children (aged 1-16 years, mean± SD: 8.7±4.4 years; 47.5% girls) were randomised to receive insulin pump treatment with continuous glucose monitoring or conventional self-monitoring blood glucose measurements. The primary outcome was the level of HbA 1c after 12 months. Other analyses included fasting C-peptide, glycaemic variability, sensor usage, adverse events, children's health-related quality of life and parent's wellbeing. Results HbA 1c was not significantly different between the two groups, but patients with regular sensor use had lower values (mean 7.1%, 95% CI 6.8-7.4%) compared with the combined group with no or low sensor usage (mean 7.6%, 95% CI 7.3-7.9%; p=0.032). At 12 months, glycaemic variability was lower in the sensor group (mean amplitude of glycaemic excursions 80.2 ± 26.2 vs 92.0 ± 33.7; p=0.037). Higher C-peptide concentrations were seen in sensor-treated 12-to 16-year-old patients (0.25±0.12 nmol/l) Electronic supplementary material The online version of this article

Aims/hypothesis To assess the use of paediatric continuous subcutaneous infusion (CSII) under real-life conditions by analysing data recorded for up to 90 days and relating them to outcome.Methods Pump programming data from patients aged 0-18 years treated with CSII in 30 centres from 16 European countries and Israel were recorded during routine clinical visits. HbA 1c was measured centrally.Electronic supplementary material The online version of this article

Patients using at least one D-W/S-W bolus per day achieved a recommended level of HbA1c. Paediatric patients with type 1 diabetes mellitus were found to be able to apply D-W/S-W boluses in daily self-treatment process based on food counting.

No abstract

Aims/hypothesis We investigated the potential effects of the Continuous Glucose Monitoring System (CGMS), as compared with self-monitoring of blood glucose, on glycaemic control in children with type 1 diabetes. Methods The following electronic databases were searched throughout June 2007: MEDLINE, EMBASE and The Cochrane Library. Additional references were obtained from reviewed articles. Only randomised controlled trials were included. Results We included five trials involving 131 type 1 diabetic patients in the study. Combined data from all trials showed that the CGMS did not significantly reduce HbA 1c levels compared with control groups. The pooled weighted mean difference was −0.02% (95% CI −0.29 to 0.25) with a fixed model and remained insignificant in the random effect model. Sensitivity analysis determined that the findings were stable. There was a trend towards a longer time under the CGMS curve for glucose <3.89 mmol/l in the CGMS group compared with the control group (mean difference 49.00 min, 95% CI −18.00 to 116.00). The CGMS significantly increased the number of insulin dose changes per patient per month for those managed with CGMS compared with the control groups (mean difference 6.3 changes, 95% CI 2.88-9.72). Conclusions/interpretation The Continuous Glucose Monitoring System is not better than self-monitoring of blood glucose with regard to improvement of metabolic control among type 1 diabetic children. However, due to the small number of participants and methodological limitations of the studies included, findings of this meta-analysis should be interpreted with caution.

CSII may be safely and efficiently used in children with type 1 diabetes in different age groups. This method of treatment requires regular visits to an outpatient clinic, proper education, and frequent revisions of the pump's memory.