Long-term outcome of insulin pump therapy in children with type 1 diabetes assessed in a large population-based case–control study

Abstract

Aims/hypothesis We determined the impact of insulin pump therapy on long-term glycaemic control, BMI, rate of severe hypoglycaemia and diabetic ketoacidosis (DKA) in children. Methods Patients on pump therapy at a single paediatric tertiary hospital were matched to patients treated by injections on the basis of age, duration of diabetes and HbA 1c at the time of pump start. HbA 1c , anthropometric data, episodes of severe hypoglycaemia and rates of hospitalisation for DKA were collected prospectively.

Hospital admission for diabetic ketoacidosis or severe hypoglycemia in 31 330 young patients with type 1 diabetes

“…There was a trend to a lower rate of hospital admission for severe hypoglycemia in patients using insulin pumps in our cohort but without significant difference after multivariable adjustment. This finding is concordant with other studies reporting lower rates for severe hypoglycemia in patients on insulin pump treatment (7,10,13). One strength of this study is its population-based multicenter database, including more than 30 000 young individuals with established type 1 diabetes, permitting analysis of demographic and treatment variables as risk factors of DKA and of severe hypoglycemia.…”

“…However, direct comparison is difficult in observational data, as patients are not randomized to pump therapy, but specific indications lead to the initiation of insulin pump therapy. In a report from Sweden, twofold higher ketoacidosis rates were described in patients using insulin pumps compared to individuals with type 1 diabetes using insulin injections (14), while more recent studies reported lower ketoacidosis rates in pump users than in those using injections (7,10). There was a trend to a lower rate of hospital admission for severe hypoglycemia in patients using insulin pumps in our cohort but without significant difference after multivariable adjustment.…”

“…Diabetic ketoacidosis (DKA) accounts for 13% (2,3) to 19% (4) of disease-related mortality and occurs at a rate of 1-10/100 patient-years in children and adolescents with established diabetes remaining largely constant within the last decade (1,5,6,7). In contrast, the incidence of severe hypoglycemia has decreased during the past decade and recent reports refer to rates of 16-20/100 patient-years for severe hypoglycemia (defined as requiring assistance from another person) and 2-8/100 patient-years for hypoglycemic coma (loss of consciousness or seizures) (1,7,8,9,10,11), accounting for 4-10% (2, 3, 4, 12) of diseaserelated mortality.…”

“…In addition, treatmentrelated variables such as HbA1c (6,7) and insulin treatment regimen (use of insulin pump or multiple daily insulin injections) (7,10,13,14) have been shown to affect the risk of DKA and severe hypoglycemia. These studies were mainly center-based and performed in small cohorts of children and adolescents with type 1 diabetes (6,7,10,13,14).…”

An introduction to insulin pump therapy

“…This is supported by NICE for children under 12 years, although those over 12 should be treated with the same guidelines as adults. 11 Many paediatric centres in the UK now use insulin pump therapy as first-line treatment upon diagnosis of type 1 diabetes.…”