Continuous subcutaneous insulin infusion - A new way to lower risk of severe hypoglycemia, improve metabolic control, and enhance coping in adolescents with type 1 diabetes

OBJECTIVE- Recommendations from the Diabetes Control and Complications Tria l (DCCT) indicate that adolescents with type 1 diabetes should be treated w ith intensive therapy involving multiple daily injections (MDI) of insulin or insulin pump therapy (continuous subcutaneous insulin infusion [CSII]) t o help obtain better metabolic control and prevent later complications. Int erest has thus focused on insulin pump therapy to help adolescents meet thi s challenge. The purpose of this study was to examine responses to CSII and MDI in a large group of adolescents with established type 1 diabetes durin g a 12-month period and to determine whether either treatment regimen more favorably affected clinical and psychosocial outcomes. RESEARCH DESIGN AND METHODS - One-third of 75 youths aged 12-20 years who w ere candidates for intensive therapy chose CSII as their mode of treatment. Patients received intensive treatment and education as described by the DC CT investigators. Psychosocial data (e,g., quality of life, depression, sel f-efficacy and coping) were collected at baseline and at 6-month intervals, and clinical data (e.g., HbA(1c) levels, adverse events) were collected ev er 4-6 weeks. RESULTS - Although both MDI- and CSII-treated adolescents initially exhibit ed improved metabolic control, this level of control was more difficult to sustain for 12 months in the MDI group (at 6 months HbA(1c), = 8.1, at 12 m onths HbA(1c), = 8.3), whereas average HbA(1c), levels in the CSII group co ntinued to decrease during the 12 months of treatment (at 6 months HbA(1c) = 7.7, at 12 months HbA(1c) = 7.5). Despite lower HbA(1c) levels in CSII- v ersus MDI-treated patients, the rate of severe hypoglycemic events was redu ced by almost 50% in the CSII group (P = 0.01). Self-reported questionnaire s demonstrated that there was improvement in self-efficacy, depression, and quality of life in both MDI- and CSII-treated patients. Finally adolescent s using CSII found coping with diabetes to be less difficult than adolescen ts using MDI did. CONCLUSIONS - CSII is an alternative means to lower HbA(1c) levels and redu ce the risk of hypoglycemia without adversely affecting psychosocial outcom es in adolescents with type 1 diabetes.