Insulin Pump Therapy Started at the Time of Diagnosis: Effects on Glycemic Control and Pancreatic β-Cell Function in Type 1 Diabetes

Thrailkill, Kathryn M.; Moreau, Cynthia; Swearingen, Christopher J.; Rettiganti, Mallik; Edwards, Kathy; Morales, Alba; Kemp, Stephen F.; Frindik, J. Paul; Fowlkes, John L.

doi:10.1089/dia.2011.0085

Cited by 26 publications

(26 citation statements)

References 25 publications

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“…22,23 Some subsequent intervention studies, but with a short follow-up duration (£24 months), showed that an early pump commencement has a favorable effect on residual b-cell function and glycemic control 24,25 and that using a sensoraugmented pump led to similar results. 26,27 It is possible that the better glycemic control observed in our study in the first and second quartiles is related to a better preservation of residual b-cell function; in other words, an early pump commencement could prolong the honeymoon phase.…”

Section: Discussionmentioning

confidence: 99%

The Effectiveness and Durability of an Early Insulin Pump Therapy in Children and Adolescents with Type 1 Diabetes Mellitus

BrancatoDavide¹,

FleresMattia²,

AielloVito³

et al. 2014

Diabetes Technology & Therapeutics

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Background: This study evaluated the predictors of effectiveness and durability of insulin pump therapy in children and adolescents who have initiated continuous subcutaneous insulin infusion (CSII) within 2 years after the diagnosis of type 1 diabetes mellitus (T1DM). Subjects and Methods: The charts of individuals with T1DM using insulin pumps who were treated at our center were reviewed, including subjects with age at onset of <22 years, interval between onset and insulin pump commencement (interval onset-commencement) of <2 years, use of pumps of >1 year, and use of glucose sensors for <4 weeks/year. The primary end point was the mean glycosylated hemoglobin (HbA1c) value (MHbA1c) throughout the follow-up. Results: From 684 patients treated with insulin pumps, 119 met the inclusion criteria, and 113 were selected for statistical analysis (60 females; age at diabetes onset, 8.9 -5.6 years [mean -SD]; follow-up, 4.0 -1.8 years; range, 1-8 years; baseline HbA1c, 9.3 -1.8%). Only the interval onset-commencement was a linear predictor of the MHbA1c (P = 0.01; R 2 = 0.089). A significant reduction of the mean yearly HbA1c from baseline throughout all the follow-up was observed (P < 0.001). Categorizing the sample into four quartiles on the basis of an increasing interval onset-commencement resulted in levels of MHbA1c significantly lower in the first and second quartiles in comparison with the fourth quartile (7.6 -0.8% and 7.8 -1.0%, respectively, versus 8.5 -0.8%; P < 0.001 and P = 0.004, respectively). Conclusions: The present study suggests that early pump commencement in children and adolescents with T1DM provides lower and more durable HbA1c values than a late commencement. It is possible that an early pump commencement could prolong the honeymoon phase, but we cannot confirm or exclude this hypothesis because the lack of data about C-peptide levels during the follow-up.

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Section: Discussionmentioning

confidence: 99%

The Effectiveness and Durability of an Early Insulin Pump Therapy in Children and Adolescents with Type 1 Diabetes Mellitus

BrancatoDavide¹,

FleresMattia²,

AielloVito³

et al. 2014

Diabetes Technology & Therapeutics

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show abstract

“…8,15 However, among the seven participating pediatric diabetes centers, the incidence of pump use early in the course of childhood diabetes varied. Racial/ethnic group, insurance status, and household income appeared to influence whether …”

Section: Discussionmentioning

confidence: 99%

“…7 Furthermore, initiation of insulin pump therapy at diagnosis has been shown to improve glycemic control. 8 Over the past 10 years, increasing numbers of children and adolescents with T1D have been placed on insulin pump therapy, and large numbers of clinical outcome studies have confirmed the benefits of pump therapy in the pediatric age group. [3][4][5]9,10 Nevertheless, data are limited regarding realworld patterns of pump use during the first year of treatment of T1D in children and adolescents and the clinical and socioeconomic factors that are associated with early use of pump therapy.…”

Section: Which In Turnmentioning

confidence: 99%

Race, Socioeconomic Status, and Treatment Center Are Associated with Insulin Pump Therapy in Youth in the First Year Following Diagnosis of Type 1 Diabetes

Lin

Connor

Ruedy

et al. 2013

Diabetes Technology & Therapeutics

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“…It has also been suggested that the type of insulin treatment may modulate the duration of this phase. A strict glycaemic control either with basal bolus [24] or with an insulin pump [25] has been shown to extend the honeymoon phase.…”

Section: The Remission Phase In Paediatric T1dmentioning

confidence: 99%

Remission Phase in Paediatric Type 1 Diabetes: New Understanding and Emerging Biomarkers

Fonolleda¹,

Murillo²,

Vázquez

et al. 2017

Horm Res Paediatr

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Type 1 diabetes (T1D) is a metabolic disease of unknown aetiology that results from the autoimmune destruction of the β-cells. Clinical onset with classic hyperglycaemic symptoms occurs much more frequently in children and young adults, when less than 30% of β-cells remain. Exogenous insulin administration is the only treatment for patients. However, due to glucose dysregulation, severe complications develop gradually. Recently, an increase in T1D incidence has been reported worldwide, especially in children. Shortly after diagnosis, T1D patients often experience partial remission called “honeymoon phase,” which lasts a few months, with minor requirements of exogenous insulin. In this stage, the remaining β-cells are still able to produce enough insulin to reduce the administration of exogenous insulin. A recovery of immunological tolerance to β-cell autoantigens could explain the regeneration attempt in this remission phase. This mini-review focuses on the remission phase in childhood T1D. Understanding this period and finding those peripheral biomarkers that are signs of immunoregulation or islet regeneration could contribute to the identification of patients with a better glycaemic prognosis and a lower risk of secondary complications. This remission phase could be a good checkpoint for the administration of future immunotherapies.

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Insulin Pump Therapy Started at the Time of Diagnosis: Effects on Glycemic Control and Pancreatic β-Cell Function in Type 1 Diabetes

Cited by 26 publications

References 25 publications

The Effectiveness and Durability of an Early Insulin Pump Therapy in Children and Adolescents with Type 1 Diabetes Mellitus

The Effectiveness and Durability of an Early Insulin Pump Therapy in Children and Adolescents with Type 1 Diabetes Mellitus

Race, Socioeconomic Status, and Treatment Center Are Associated with Insulin Pump Therapy in Youth in the First Year Following Diagnosis of Type 1 Diabetes

Remission Phase in Paediatric Type 1 Diabetes: New Understanding and Emerging Biomarkers

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