Continuous subcutaneous insulin infusion therapy for children and adolescents: An option for routine diabetes care

Objective. The purpose of this study was to determine the feasibility of co ntinuous subcutaneous insulin infusion (CSII) (insulin pump) therapy in rou tine pediatric diabetes care by comparing the HbA(1c), body mass index (BMI ), and hypoglycemic episodes before and after initiation of CSII therapy. Research Design and Methods. Data from 56 patients (7-23 years old) were co llected during regularly scheduled visits at a frequency similar to non-CSI I patients. Results. The data were analyzed for the entire cohort and 3 subgroups (decr eased, stable, or increased HbA1c) stratified according to a greater than o r equal to0.5% change in HbA(1c). The total cohort demonstrated a decrease in HbA(1c) from 8.5% to 8.3%. The decreased cohort (39.4% of the total coho rt) demonstrated a significant decrease in HbA(1c) from 8.6% to 7.6%. The m ean HbA(1c) of the stable cohort (41.0%) was 8.7%. The increased cohort (19 .6%) had an increase in HbA(1c) from 7.8% to 8.8%. Thirty-six patients (64. 3%) maintained or achieved a HbA(1c) <8.0% or achieved a HbA(1c) at least 1 % lower than their pre-CSII level. Of concern, 6 patients (10.7%) demonstra ted a clinically significant increase in HbA(1c) from 8.3% to 9.6%. For the entire cohort, the rate of severe hypoglycemia before and on CSII therapy was 12.3 and 9.5 events per 100 patient-years, respectively. A statisticall y significant proportion of patients reported a decrease in seizure frequen cy versus an increase (17.9% vs 1.8%) as well as a decrease in overall hypo glycemic frequency versus an increase (41.1% vs 17.9%). There was not a cli nically significant increase in BMI, even in the decreased HbA(1c) cohort. Conclusions. CSII therapy is an appropriate option for some children in rou tine pediatric diabetes care. It can effectively decrease the HbA(1c) and r educe hypoglycemic episodes, without producing an abnormal increase in BMI.