Insulin pump use in young children in the T1D Exchange clinic registry is associated with lower hemoglobin A1c levels than injection therapy

Abstract

Insulin delivery via injection and continuous subcutaneous insulin infusion (CSII) via insulin pump were compared in a cross-sectional study (n = 669) and retrospective longitudinal study (n = 1904) of young children (<6 yr) with type 1 diabetes (T1D) participating in the T1D Exchange clinic registry. Use of CSII correlated with longer T1D duration (p < 0.001), higher parental education (p < 0.001), and annual household income (p < 0.006) but not with race/ethnicity. Wide variation in pump use was observed among T1D Exchange centers even after adjusting for these factors, suggesting that prescriber preference is a substantial determinant of CSII use. Hemoglobin A1c (HbA1c) was lower in pump vs. injection users (7.9 vs. 8.5%, adjusted p < 0.001) in the cross-sectional study. In the longitudinal study, HbA1c decreased after initiation of CSII by 0.2%, on average (p < 0.001). Frequency of a severe hypoglycemia (SH) event did not differ in pump vs. injection users (p = 0.2). Frequency of ≥1 parent-reported diabetic ketoacidosis (DKA) event in the prior year was greater in pump users than injection users (10 vs. 8%, p = 0.04). No differences between pump and injection users were observed for clinic-reported DKA events. Children below 6 yr have many unique metabolic characteristics, feeding behaviors, and care needs compared with older children and adolescents. These data support the use of insulin pumps in this youngest age group, and suggest that metabolic control may be improved without increasing the frequency of SH, but care should be taken as to the possibly increased risk of DKA.

New Approaches to Providing Individualized Diabetes Care in the 21st Century

“…Similarly, use of personal CGMs is emerging in pediatric T1D patients particularly as accuracy and functionality of these devices continues to improve, and the additional information provided by these devices can assist with adjustments and fine-tuning of doses between clinic visits [81]. Additionally, advances in the comfort of sensors and infusion sets will continue to contribute to both clinical and quality of life benefits from these devices, which have the potential to improve patient outcomes and management between clinic visits [3, 82–84]. …”

“…In recent years, pharmacological advances have been further enhanced by technology that allows for more accurate and timely monitoring of glucose levels, including continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusion (CSII), or insulin pumps, that enable more sophisticated patterns of insulin delivery to better match patient requirements. Despite documented benefits [2, 3], uptake of these diabetes technologies is variable [3–4] and CSII may not meet the needs of all patients. Implementation of any currently available treatment regimens is multifaceted and one approach will not work for all situations.…”

The Benefits of Insulin Pump Therapy in Children and Adolescents with Type 1 Diabetes

“…In a large crosssectional study of 669 children under the age of 6 from the T1D Exchange Clinic Registry, HbA1c was 0.7% lower in children using insulin pumps compared to those taking injections (Blackman et al, 2014).…”

A Type 1 diabetes technology pathway: consensus statement for the use of technology in Type 1 diabetes

“…Data from these registries offer real-world insights into factors associated with greater achievement of glucose targets. Indeed, both CSII and CGM have a large body of randomized controlled trial (RCT) as well as real-world observational evidence demonstrating benefits to people with Type 1 diabetes in terms of improved HbA 1c , reduced hypoglycaemia and improved quality of life [8,[10][11][12][13][14][15]. Indeed, both CSII and CGM have a large body of randomized controlled trial (RCT) as well as real-world observational evidence demonstrating benefits to people with Type 1 diabetes in terms of improved HbA 1c , reduced hypoglycaemia and improved quality of life [8,[10][11][12][13][14][15].…”