Long-term Efficacy of Insulin Pump Therapy in Children with Type 1 Diabetes Mellitus

Abstract

Objective: Insulin pumps have been well established for insulin delivery. However, questions about long-term efficacy of insulin pump therapy still remain. We evaluated the long-term efficacy of continuous insulin infusion pump therapy (CSII) in pediatric patients with type 1 diabetes mellitus (T1DM).Methods: This was a retrospective observational study which included 131 patients with T1DM who transitioned to an insulin pump from multiple daily insulin (MDI) injections between 1999 and 2009 and were followed by one endocrinologist. Data were collected from 6 months prior to switching to CSII to 30 months after initiation of CSII and included glycated hemoglobin (HbA1c) and insulin requirement. Of the 131 patients, 45 had complete data consisting of a visit and HbA1c every 6 months for 30 months after transition to CSII and were included for analysis. Results: Mean HbA1c prior to starting the CSII was 8.0 +0.9 %, 7.7 +1.0 % at 6 months and 7.8+1.2 % at 1 yr post initiation of CSII. However, at 30 months, HbA1c increased to 8.0+1.3%. A trend in transient improvement in HbA1c was limited only to those patients >11 yr of age and those requiring >0.75 u/kg/day of insulin at transition and was not seen in those <11 yr of age or those requiring <0.75 u/kg/day and did not persist beyond 1 year. Conclusions: There was no long-term significant difference in glycemic control in patients with CSII as compared to MDI. Conflict of interest:None declared.

Effectiveness of Multiple Daily Injections or Continuous Subcutaneous Insulin Infusion for Children with Type 1 Diabetes Mellitus in Clinical Practice

“…Some studies have shown that the HbA1c level is not related to the number of insulin injections [13]. We believe that the results of our study are in agreement with the finding that compliance with and desire for better glycemic control are more important than the insulin delivery method [14], as they strengthen patients' self-management abilities. Because our study was retrospective and no information about diet and exercise was available for our outpatients, we could not evaluate their comprehensive management abilities.…”

Long-Term Efficacy of Insulin Pump Therapy on Glycemic Control in Adults with Type 1 Diabetes Mellitus

“…Plotnick et al 7 found only transient improvement in HbA1c at 3-6 months after pump therapy. Batajoo et al 8 found no difference in glycemic control in patients on insulin pump therapy compared with MDI at 30 months of follow-up. In contrast, Nimri et al 9 reported longterm improvement in children with type 1 diabetes after initiation of insulin pump therapy, as did Weinzimer et al 10 Only three studies have examined the long-term efficacy of insulin pumps in adults.…”

Real‐world outcomes of insulin pump compared to injection therapy in a population‐based sample of children with type 1 diabetes

“…The strength of this study is that although it is not a RCT, it analyses “real‐world” outcomes of a large population‐based cohort over a longer duration than previously reported. It differs from other pediatric studies which often include only a small number of patients, have a much shorter follow‐up time, and do not include a control group (patients on injection therapy) . Furthermore, data in this study come from a population‐based database with high case ascertainment, and pairs were matched with a random‐sampling algorithm that minimizes a potential selection bias.…”

“…It differs from other pediatric studies which often include only a small number of patients, have a much shorter follow-up time, and do not include a control group (patients on injection therapy). [6][7][8][9][10] Furthermore, data in this study come from a population-based database with high case ascertainment, and pairs were matched with a random-sampling algorithm that minimizes a potential selection bias. There are few pediatric randomized controlled trials comparing patients on pump therapy and patients on injection therapy, and all have a duration of less than 1 year.…”