Association of Insulin Pump Therapy vs Insulin Injection Therapy With Severe Hypoglycemia, Ketoacidosis, and Glycemic Control Among Children, Adolescents, and Young Adults With Type 1 Diabetes

Karges, Beate; Schwandt, Anke; Heidtmann, Bettina; Kordonouri, Olga; Binder, Elisabeth B.; Schierloh, Ulrike; Boettcher, Claudia; Kapellen, Thomas; Rosenbauer, Joachim; Holl, Reinhard W.

doi:10.1001/jama.2017.13994

Cited by 340 publications

(282 citation statements)

References 43 publications

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“…In the early days of insulin pump therapy, DKA was more common than in patients using injection therapy (only rapid‐ or short‐acting insulin is used in pumps; therefore, interruption of insulin delivery for any reason rapidly leads to insulin deficiency) . However, a recent matched comparison of patients using insulin pump therapy with multiple daily injections showed that DKA occurred less frequently (3.64 vs 4.26 per 100 patient‐years) in patients using pump therapy …”

Section: Frequency Of Dkamentioning

confidence: 99%

ISPAD Clinical Practice Consensus Guidelines 2018: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state

et al. 2018

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Section: Frequency Of Dkamentioning

confidence: 99%

ISPAD Clinical Practice Consensus Guidelines 2018: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state

et al. 2018

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“…Despite evidence that these new devices could lower HbA 1c levels and reduce the risks of diabetic ketoacidosis and severe hypoglycemia, their uptake in youth with diabetes was markedly delayed (12). It was not until the turn of the century that use of pump therapy became commonplace in the pediatric population.…”

Section: Why Is Integration Of Pumps and Sensors In Youth With T1d Crmentioning

confidence: 99%

Closing the Loop on Managing Youth With Type 1 Diabetes: Children Are Not Just Small Adults

Sherr

2018

Diabetes Care

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As hybrid closed-loop (HCL) insulin delivery systems permeate clinical practice, it is critical to ensure all with diabetes are afforded the opportunity to benefit from this technology. Indeed, due to the suboptimal control achieved by the vast majority of youth with type 1 diabetes (T1D), pediatric patients are positioned to see the greatest benefit from automated insulin delivery systems. To ensure these systems are well poised to deliver the promise of more targeted control, it is essential to understand the unique characteristics and factors of childhood. Herein, the developmental and physiological needs ofyouth with T1Dare reviewed and consideration is given to how HCL could address these issues. Studies of HCL technologies in youth are briefly reviewed. As future-generation closed-loop systems are being devised, features that could make this technology more attractive to youth and to their families are discussed. Integration of HCL has the potential to minimize the burden of this chronic medical condition while improving glycemic control and ultimately allowing our pediatric patients to fulfill the primary goal of childhood, to be a kid."Children are not small adults" is a phrase that every pediatric practitioner becomes well aware of during training. Indeed, the developmental changes that are the hallmark of this stage of life will never be recapitulated. In growing children with type 1 diabetes (T1D), the burden of having to constantly adjust insulin needs is a neverending challenge, especially when growth and development accelerate during puberty. It is not surprising that the summit of suboptimal control of T1D is observed in adolescence (1). Pivotal trials of new drugs and technologies for diabetes are typically carried out first in adults, not only to avoid unnecessary exposure of children to unexpected adverse effects of new therapies but also because near-optimal control of T1D is much more common in adults than in children and adolescents. Thus, it is of utmost importance to consider factors that require special attention during childhood.In our youngest patients, the inability to communicate needs may lead caregivers to adopt a strategy of constant vigilance (2). Despite such vigilance, it was reported that 90% of hypoglycemic events detected by blinded continuous glucose monitoring (CGM) in infants and toddlers occurred without concomitant symptoms of hypoglycemia detected by their caregivers (3). Due to unpredictable changes in appetite and food intake, many families of young children administer meal boluses after instead of before eating, even at the expense of greater postprandial hyperglycemia and the suboptimal glycemic control that this approach is associated with (4). Nighttime is often the worst time for parents of young children with diabetes due to fears about hypoglycemia, which leads to disturbed sleep patterns secondary to the need to monitor overnight blood glucose levels two or more times per night (5,6).School-aged children are in the care of numerous adults throughout the day: p...

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“…In an earlier study of the T1D Exchange Registry (T1DX), only 6% of children <13 years and 4% of adolescents 13 to <18 years were using CGM . Previously, DPV (Prospective Diabetes Follow‐Up Registry) data were used to compare pump and injection users . In the DPV registry, rates of CGM use were even lower; however, reimbursement by health insurance for CGM in Germany and Austria recently started in summer of 2016.…”

Section: Introductionmentioning

confidence: 99%

Continuous glucose monitoring and glycemic control among youth with type 1 diabetes: International comparison from the T1D Exchange and DPV Initiative

et al. 2018

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Background To assess change in rates of pediatric real time or intermittent scanning CGM use over the past 5 years, and how it impacts glycemic control, data from 2 registries were compared: the US-based T1DX and the German/Austrian DPV. Methods Registry participants aged <18 years with T1D duration ≥ 1 year encompassed 29,007 individuals in 2011 and 29,150 participants in 2016. Demographic data, CGM use and HbA1c were obtained from medical records. Results CGM use increased from 2011 to 2016 in both registries across all age groups, regardless of gender, ethnic minority status or insulin delivery method. The increase in CGM use was most pronounced in the youngest patients, and usage rates remain lowest for adolescent patients in 2016. For both registries in 2016, mean HbA1c was lower among CGM users regardless of insulin delivery method compared to pump only (P<0.001) and injection only (P<0.001), and CGM users were more likely to achieve glycemic target of HbA1c <7.5% (56% vs. 43% for DPV and 30% vs. 15% for T1DX, P<0.001). T1DX participants had a higher mean HbA1c compared with DPV despite whether they were CGM users or non-users; however, the difference was less pronounced in CGM users (P<0.001). Conclusions/interpretation Pediatric CGM use increased in both registries and was associated with lower mean HbA1c regardless of insulin delivery modality.

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Association of Insulin Pump Therapy vs Insulin Injection Therapy With Severe Hypoglycemia, Ketoacidosis, and Glycemic Control Among Children, Adolescents, and Young Adults With Type 1 Diabetes

Cited by 340 publications

References 43 publications

ISPAD Clinical Practice Consensus Guidelines 2018: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state

ISPAD Clinical Practice Consensus Guidelines 2018: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state

Closing the Loop on Managing Youth With Type 1 Diabetes: Children Are Not Just Small Adults

Continuous glucose monitoring and glycemic control among youth with type 1 diabetes: International comparison from the T1D Exchange and DPV Initiative

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