Use of insulin pump therapy at nighttime only for children 7-10 years of age with type 1 diabetes

OBJECTIVE - Because of age-related developmental and cognitive issues, chil dren <10 years of age may not be able to wear an insulin pump safely when t hey are not under direct parental supervision. The purpose of this study wa s to determine if insulin pump therapy at nighttime only, when children are at home, could improve fasting and nighttime blood glucose levels without adverse effects. RESEARCH DESIGN AND METHODS - The study cohort consisted of 10 children age d 7-10 years. A randomized crossover design was used to compare nighttime-o nly pump usage from dinner and throughout the night, combined with a prebre akfast injection of intermediate-acting NPH and rapid-acting lispro insulin , with 3 insulin injections per day. Comparisons were made among mean blood glucose values and percentage of blood glucose levels within the target ra nge (70-150 mg/dl) before meals, at bedtime, and at 3:00 A.M.; serum fructo samine levels; and scores on measures of adherence and fear of hypoglycemia . RESULTS - Compared with baseline levels, the use of the pump resulted in a significant decrease in the mean average (P < 0.001), breakfast (P < 0.0001 ), and 3:00 A.M. (P < 0.003) blood glucose levels. There was a decrease in the percentage of blood glucose values less than the target range (P < 0.01 ) and in fructosamine (P < 0.01) values and an increase in the percentage o f blood glucose levels within the target range (P < 0.03). CONCLUSIONS - Nighttime-only insulin pump therapy may be a viable alternati ve that young children can use to improve glycemia when they are not capabl e of independently managing an insulin pump.