In the Journals

Insulin pump therapy lowers HbA1c, hypoglycemic events in children

Spanish children with type 1 diabetes switched from multiple daily injection therapy to insulin pump therapy saw sustained improvement in HbA1c and a decrease in hypoglycemic events over 3 years, according to recent study data.

In a retrospective longitudinal study, Esmeralda Colino, of the Pediatric Diabetes Unit at Ramon y Cajal Hospital in Madrid, and colleagues analyzed data from 90 children with type 1 diabetes switched to insulin pump therapy between 2003 and 2012 and followed for a mean of 3.5 years (58% boys; all white; mean age to initiate pump therapy, 10 years; average diabetes duration, 4.4 years). Within the cohort, 21 children were preschoolers (younger than 6 years); 28 children were prepubertal; 41 children were pubertal. All patients and their families completed a diabetes unit training program before initiating pump therapy, including 25 hours of instruction over 4 days. Researchers measured insulin doses, HbA1c, insulin-to-carbohydrate ratios, number of basal rates per day, severe hypoglycemic events and episodes of diabetic ketoacidosis (DKA).

After 1 year of pump therapy, HbA1c fell from a mean of 6.9% to 6.7% (P < .001); 96% of children had HbA1c of 7.5% or less at 1 year. In subgroup analyses, researchers found the largest improvements in the preschooler and prepubertal groups, in those using neutral protamine Hagedorn (NPH) insulin and in those with the highest baseline HbA1c.

“The results in the preschoolers group were especially significant, given all the difficulties typical of this age,” the researchers wrote. “This group achieved the best results.”

Total insulin dose also decreased at 1 year, from 0.89 UI/kg to 0.73 UI/kg per day (P < .001), whereas the proportion of basal to total insulin fell from 47% to 42% (P < .05). Episodes of severe hypoglycemia fell from 19 to 6.9 episodes per 100 patient-years (22 episodes in 14 patients); one patient experienced DKA twice.

Before initiating pump therapy, 76% of children in the cohort met International Society for Pediatric and Adolescent Diabetes, International Diabetes Federation and American Diabetes Association goals for good metabolic control; at 2 years, 95% of patients were meeting the criteria. Researchers attributed the outcomes, in part, to intensive diabetic education and training and frequent self-blood glucose monitoring in the cohort. – by Regina Schaffer

Disclosure: One of the study authors reports receiving speaking fees from Lifescan, Lilly, Novo Nordisk, Medtronic and Roche, and serves as an advisory board member for Lilly, Medtronic and Novo Nordisk.

Spanish children with type 1 diabetes switched from multiple daily injection therapy to insulin pump therapy saw sustained improvement in HbA1c and a decrease in hypoglycemic events over 3 years, according to recent study data.

In a retrospective longitudinal study, Esmeralda Colino, of the Pediatric Diabetes Unit at Ramon y Cajal Hospital in Madrid, and colleagues analyzed data from 90 children with type 1 diabetes switched to insulin pump therapy between 2003 and 2012 and followed for a mean of 3.5 years (58% boys; all white; mean age to initiate pump therapy, 10 years; average diabetes duration, 4.4 years). Within the cohort, 21 children were preschoolers (younger than 6 years); 28 children were prepubertal; 41 children were pubertal. All patients and their families completed a diabetes unit training program before initiating pump therapy, including 25 hours of instruction over 4 days. Researchers measured insulin doses, HbA1c, insulin-to-carbohydrate ratios, number of basal rates per day, severe hypoglycemic events and episodes of diabetic ketoacidosis (DKA).

After 1 year of pump therapy, HbA1c fell from a mean of 6.9% to 6.7% (P < .001); 96% of children had HbA1c of 7.5% or less at 1 year. In subgroup analyses, researchers found the largest improvements in the preschooler and prepubertal groups, in those using neutral protamine Hagedorn (NPH) insulin and in those with the highest baseline HbA1c.

“The results in the preschoolers group were especially significant, given all the difficulties typical of this age,” the researchers wrote. “This group achieved the best results.”

Total insulin dose also decreased at 1 year, from 0.89 UI/kg to 0.73 UI/kg per day (P < .001), whereas the proportion of basal to total insulin fell from 47% to 42% (P < .05). Episodes of severe hypoglycemia fell from 19 to 6.9 episodes per 100 patient-years (22 episodes in 14 patients); one patient experienced DKA twice.

Before initiating pump therapy, 76% of children in the cohort met International Society for Pediatric and Adolescent Diabetes, International Diabetes Federation and American Diabetes Association goals for good metabolic control; at 2 years, 95% of patients were meeting the criteria. Researchers attributed the outcomes, in part, to intensive diabetic education and training and frequent self-blood glucose monitoring in the cohort. – by Regina Schaffer

Disclosure: One of the study authors reports receiving speaking fees from Lifescan, Lilly, Novo Nordisk, Medtronic and Roche, and serves as an advisory board member for Lilly, Medtronic and Novo Nordisk.