Three-year comparison of subcutaneous insulin pump treatment with multi-daily injections on HbA1c, its variability and hospital burden of children with type 1 diabetes

Abstract

Treatment with continuous subcutaneous insulin infusion (CSII) allows a large degree of treatment individualization and intensification in children with diabetes. The study’s aim was to evaluate the impact of treatment with CSII on glycated haemoglobin level (HbA1c) in children with diabetes and investigate whether introduction of CSII is associated with an increased risk of acute complications of diabetes. Patients treated throughout the recruitment period exclusively with multiple daily injections (MDI) were matched for duration of diabetes and HbA1c level at baseline with patients treated exclusively with CSII in a 1:1 group ratio (n = 223 and 231 for MDI and CSII, respectively). The CSII group showed lower HbA1c after the observation period (7.98 ± 1.38 vs. 7.56 ± 0.97; P = 0.002). HbA1c variability measured as standard deviations of average values was also lower in the CSII group (0.73 ± 0.45 vs. 0.84 ± 0.54; P = 0.049). The rate of hospitalization due to acute events was similar in both groups (14.7/100 vs. 14.0/100 person/years in the MDI and CSII group, P = 0.72). Duration of hospital stay per year was on average 1.25 days shorter in the CSII group (P = 0.0004), but the risk of acute complications resulting in hospitalization did not differ between the groups (hazard ratio (HR) 1.16; 95% confidence interval (95% CI) 0.68–1.63). The most significant risk factor for hospitalization due to acute complications was baseline HbA1c concentration (HR 1.25; 95% CI 1.14–1.37). In conclusion, CSII treatment may improve glycemic control and reduce its variability. Change of MDI to CSII does not alter the risk of hospitalization and may reduce the annual duration of hospitalization in children with diabetes.Electronic supplementary materialThe online version of this article (doi:10.1007/s00592-011-0332-7) contains supplementary material, which is available to authorized users.

A systematic review of non‐genetic predictors and genetic factors of glycated haemoglobin in type 1 diabetes one year after diagnosis

“…A shorter T1D duration was significantly associated with a lower HbA1c level, even after adjusting for age and treatment . Several articles reported a strong association between the occurrence of DKA and/or microalbuminuria and HbA1c level, although no association between HbA1c level and hypoglycaemia was observed …”

“…In most studies, age was significantly and positively correlated with HbA1c level . Four small‐scale studies and one performed in a very early age at T1D onset reported non‐significant association.…”

“…The sample size range is 70 to 30 708 patients with a median sample size of 210 T1D patients. Thirty‐two studies were performed in several European countries, 31 in USA, one in Canada, three in Israel, and the rest in other countries (one in Japan, one in New‐Zealand, three in Turkey, one in Australia, and three are multinational). Most studies (54 studies) were performed on T1D children (median of mean age reported in articles 12.5 [range: 4.1‐17.7]), 22 included both children and young adults (median of mean age of 14.8 [range: 10.1‐21.6]), and one included only young adults (mean age of 19.4 ± 0.9 [range: 18‐21]).…”

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.…”

Kontrola glikemii i jej zmienność głównymi czynnikami ryzyka mikroalbuminurii u dzieci chorych na cukrzycę typu 1

“…In view of the available data, we hypothesise that variability of HbA 1c may represent a 'breakthrough' effect of a sudden deterioration of metabolic control with the associated episode of microalbuminuria, both of which are subsequently resolved. If this is the case, protection from such events may be offered by interventions aimed at reducing the variability of HbA 1c , such as the introduction of insulin pump therapy [38]. The significance of HbA 1c variability as a risk factor of microalbuminuria development in patients with type 1 and type 2 diabetes has been confirmed recently [39,40].…”