Insulin pump therapy in young children with type 1 diabetes

Bougnères, Pierre; Landier, F; Lemmel, C; Mensire, A; Chaussain, Jean‐Louis

doi:10.1016/s0022-3476(84)80115-8

Cited by 47 publications

(31 citation statements)

References 11 publications

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“…Technological difficulties with the pump. A total of 11 studies (12,14,19,32,38,41,44,46,53,68,73) reported on episodes of pump malfunction. These studies reported multiple reasons for the malfunctions.…”

Section: Glycemic Controlmentioning

confidence: 99%

Insulin Pump Therapy

2003

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OBJECTIVE -To conduct a meta-analysis of the metabolic and psychosocial impact of continuous subcutaneous insulin infusion (CSII) therapy on adults, adolescents, and children.RESEARCH DESIGN AND METHODS -Studies were identified and data regarding study design, year of publication, sample size, patient's age, diabetes duration, and duration of CSII therapy were collected. Means and SDs for glycohemoglobin, blood glucose, insulin dosages, and body weight for CSII and comparison conditions were subjected to meta-analytic procedures. Data regarding pump complications and psychosocial functioning were reviewed descriptively.RESULTS -A total of 52 studies, consisting of 1,547 patients, were included in the metaanalysis. Results indicate that CSII therapy is associated with significant improvements in glycemic control (decreased glycohemoglobin and mean blood glucose). A descriptive review of potential complications of CSII use (e.g., hypoglycemia, diabetic ketoacidosis [DKA], pump malfunction, and site infections) suggests a decreased frequency of hypoglycemic episodes but an increased frequency of DKA in studies published before 1993.CONCLUSIONS -CSII therapy is associated with improved glycemic control compared with traditional insulin therapies (conventional therapy and multiple daily injections) and does not appear to be associated with significant adverse outcomes. Additional studies are needed to further examine the relative risks of CSII therapy, including the potential psychosocial impact of this technologically advanced therapy.

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Section: Glycemic Controlmentioning

confidence: 99%

Insulin Pump Therapy

2003

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“…Much more limited studies have been conducted on the use of CSII for toddlers and preschool children (7,14,15). Most recently, Litton et al (7) reported on their experience with nine children (mean age of CSII initiation 34 months) selected to receive CSII.…”

Section: Adverse Eventsmentioning

confidence: 99%

“…Thus, CSII would appear to be an attractive treatment option for toddlers, because it may facilitate dosing of insulin for small frequent meals and insulin dosing at fine increments, serving to minimize the risk for hypoglycemia while improving overall metabolic control. CSII use in this population has been controversial, and debate has arisen as to the safety and suitability of such therapy in these young patients.There are a few small reports of CSII use for toddlers suggesting that it may be effective for this population (7,14,15).Although numerous studies in both adult and pediatric populations report …”

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confidence: 99%

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A Two-Center Randomized Controlled Feasibility Trial of Insulin Pump Therapy in Young Children With Diabetes

et al. 2005

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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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“…30 Case series carried out in the 1980s showed mixed results. [61][62][63][64] A review in 1986 summarised the finding of the early studies, and noted conflicting results. 65 Children at different ages need to be considered separately, perhaps grouped as follows;…”

Section: Subsidiary Questions Children Including Overnight Usementioning

confidence: 99%

Clinical and cost-effectiveness of continuous subcutaneous insulin infusion for diabetes

Colquitt¹,

Green²,

Sidhu³

et al. 2004

Health Technol Assess

106

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Insulin pump therapy in young children with type 1 diabetes

Cited by 47 publications

References 11 publications

Insulin Pump Therapy

Insulin Pump Therapy

A Two-Center Randomized Controlled Feasibility Trial of Insulin Pump Therapy in Young Children With Diabetes

Clinical and cost-effectiveness of continuous subcutaneous insulin infusion for diabetes

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