OBJECTIVE -Our goals were to determine if continuous subcutaneous insulin infusion (CSII), compared with those continuing multiple daily injections (MDIs), can be safely used in young children, if those on CSII will have superior glycemic control, if subjects using CSII will have less hypoglycemia for their level of control, and if families using CSII will report an improved quality of life.RESEARCH DESIGN AND METHODS -We conducted a randomized 1-year feasibility trial comparing CSII with continuing MDIs in preschool children with a history of type 1 diabetes for at least 6 months' duration. Prospective outcomes included measures of overall glycemic control (HbA 1c and continuous glucose monitoring system), the incidence of severe hypoglycemia and diabetic ketoacidosis, the percent of glucose values below 3.9 mmol/l, and the parents' report of quality of life.RESULTS -The 19 subjects' ages ranged from 1.7 to 6.1 (mean 3.6) years, duration of diabetes ranged from 0.6 to 2.6 (mean 1.4) years, and baseline HbA 1c ranged from 6.7 to 9.6% (mean 7.9%). Seven subjects were male. Nine subjects were randomized to start CSII and 10 to continue on MDI. All baseline characteristics were well balanced. Overall metabolic control, diabetes quality of life, and the incidence of hypoglycemia were similar in the two groups. No subject had diabetic ketoacidosis, while one subject in each group had an episode of severe hypoglycemia. No CSII subject discontinued using the pump during or after the study.CONCLUSIONS -CSII can be a safe and effective method to deliver insulin in young children. Diabetes Care 28:15-19, 2005S ince its introduction in the late 1970s, continuous subcutaneous insulin infusion (CSII), or insulin pump therapy, has become an increasingly popular option for type 1 diabetes management (1,2), particularly following the push for improved metabolic control in the post-Diabetes Control and Complications Trial era (3). The potential advantages of such therapy over multiple daily injections (MDIs) include ease of insulin administration, improved metabolic control with reduced swings in glucose and decreased risk of hypoglycemia, better matching of insulin to carbohydrate intake, improved coverage of the dawn phenomenon and adjustment of basal insulin delivery at other times of the day, increased flexibility in daily living, and improved coping with diabetes (4,5). Potential disadvantages of CSII relative to MDI include increased cost, inconvenience of wearing a device, risk for subcutaneous infection at the pump infusion site, and diabetic ketoacidosis.CSII has traditionally been reserved for savvy adolescents and adults, but it is gaining more widespread acceptance in children as well (6 -12). One age-group in which the technology has been used sparingly but who may benefit from CSII is infants and toddlers. Although parents or other adult supervisors are available to oversee frequent glucose monitoring and multiple insulin injections, it is usually difficult to achieve near-normal metabolic control in this populatio...

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National Institutes of Health, the Wilsey Family Foundation, and the UCSF Clinical & Translational Science Institute.

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OBJECTIVETo determine the effectiveness of an online module for reducing insulin administration errors by nurses caring for hospitalized pediatric patients.RESEARCH DESIGN AND METHODSPediatric nursing staff completed a mandatory online educational module teaching insulin pharmacokinetics and the insulin order form, using diluted insulin and finishing with 15 interactive cases. A chart audit to determine all possible insulin errors of patients receiving insulin was done before and 2–6 months after the educational module.RESULTSAll of the medical center's 283 pediatric nurses successfully completed the educational module. A total of 24 charts were audited in the preintervention phase and 22 in the postintervention phase. The preintervention insulin error rate was 14.8%, reduced to 1.7% (P < 0.001) postintervention. Improvement occurred in correct insulin dosing and type, timing of administration, and timely blood glucose monitoring and documentation.CONCLUSIONSAn interactive online educational module can be an effective strategy for reducing pediatric nurses' insulin administration errors.