OBJECTIVE -The efficacy of the insulin analogs now available for multiple daily injection (MDI) and continuous subcutaneous insulin infusion (CSII) therapy in type 1 diabetes has not yet been established in pediatric patients. Our principal aim in this short-term study was to compare the efficacy of CSII to MDI with glargine in lowering HbA 1c levels in children and adolescents with type 1 diabetes.RESEARCH DESIGN AND METHODS -Thirty-two youth with type 1 diabetes (age 8 -21 years) were randomly assigned to receive either MDI treatment with once-daily glargine and premeal/snack insulin aspart or CSII with insulin aspart. Dose titration in both groups was based on home self-monitored blood glucose measurements and monthly HbA 1c . HbA 1c , total daily insulin dose (TDD), self-monitored blood glucose readings, and adverse events were compared after 16 weeks of therapy.RESULTS -While there was no significant change in the glargine group (HbA 1c 8.2% at baseline vs. 8.1% at 16 weeks), youth randomized to CSII had a sharp reduction in HbA 1c levels, from 8.1 to 7.2% after 16 weeks of therapy (P Ͻ 0.02 vs. baseline and Ͻ0.05 vs. glargine group). TDD was unchanged in the glargine group, but significantly dropped with CSII (1.4 units/kg at baseline vs. 0.9 units/kg at 16 weeks, P Ͻ 0.01). Both groups had similar basal doses and insulin-to-carbohydrate ratios. Fasting self-monitored blood glucose was similar in both groups, but lunch, dinner, and bedtime readings were significantly lower in the CSII group (P Ͻ 0.01).CONCLUSIONS -Lower HbA 1c and premeal glucose levels were more achievable in this short-term study with CSII than with glargine-based MDI treatment. CSII is an efficacious treatment to improve metabolic control in youth with type 1 diabetes. Diabetes Care 27:1554 -1558, 2004T he Diabetes Control and Complications Trial (1,2) demonstrated the importance of lowering HbA 1c levels as close to normal as possible. The urgency to achieve strict diabetes control has contributed to a sharp increase in the use of continuous subcutaneous insulin infusion (CSII) in children with type 1 diabetes. Reports from our program (3,4) and others (5-7) have demonstrated that CSII can lower HbA 1c levels and rates of severe hypoglycemia in youth with type 1 diabetes. However, these findings can be questioned because prepump injection regimens varied in intensity and in the types of insulins that were used. Moreover, only the recent study of Weintrob et al. (7) was a randomized controlled trial of CSII versus multiple daily injections (MDIs) using NPH insulin.With intermediate-acting insulins, there are considerable dose-to-dose variations in the amount of insulin that is administered and absorbed (8). Additionally, the peaking actions of these insulins make them less than ideal for basal insulin replacement (8). These limitations have been overcome by the introduction of glargine insulin, the first soluble insulin analog that has a flat and prolonged timeaction profile. A disadvantage of MDIs with glargine is the large number of i...

CSII is an effective alternative to injection therapy in a large pediatric diabetes clinic setting. Even very young patients can utilize CSII to safely lower HbA1c levels.

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Our data suggest that pizza has properties that accentuate and sustain postprandial hyperglycemia.