Authors:
Johnson SR, Cooper MN, Jones TW, Davis EA
Authors notes:
Diabetologia. 2013:online
Keywords:
Adolescents, Children, Continuous subcutaneous insulin infusion, hypoglycaemia, Insulin pump, Metabolic control, Type 1 diabetes
Abstract:
We determined the impact of insulin pump therapy on long-term glycaemic control, BMI, rate of severe hypoglycaemia and diabetic ketoacidosis (DKA) in children.
A total of 345 patients on pump therapy were matched to controls on injections.
The mean age, duration of diabetes at pump start and length of follow-up were 11.4, 4.1 and 3.5 years, respectively.
The mean HbA1c reduction in the pump cohort was 0.6%.
This improved HbA1c remained significant throughout the 7 years of follow-up. Pump therapy reduced severe hypoglycaemia from 14.7 to 7.2 events per 100 patient-years.
In contrast, severe hypoglycaemia increased in the non-pump cohort over the same period from 6.8 to 10.2 events per 100 patient-years.
The rate of hospitalisation for DKA was lower in the pump cohort over the 1,160 patient-years of follow-up.
This is the longest and largest study of insulin pump use in children and demonstrates that pump therapy provides a sustained improvement in glycaemic control, and reductions of severe hypoglycaemia and hospitalisation for DKA compared with a matched cohort using injections.