Background: The use of insulin pumps is rapidly spreading within the paediatric T1D community. A few small studies have promoted pump usage, while large registries have shown almost no advantage of this treatment.
Objectives: Compare the results of treatment with insulin pump (Pump) with insulin injections (Inj) in a large cohort of children with T1D in field conditions.
Patients: We studied 3137 children of the ISIS-Diab cohort with ≥1 year of T1D duration recruited by 99 diabetes centers of various size covering all French regions. HbA1c, severe hypoglycemia (SH), ketoacidosis (DKA), and weight were compared between Pump (n=694) and Inj (n=2443) groups of children over their last 6 months of treatment.
Results: The ratio of Pump/Inj varied from 0 to 65% across centers. Pump children were slightly younger (9.2±3.9 years vs 10.6±3.4 years for Inj, P=2.10−6), and had comparable socio-educational level than Inj. Mean HbA1c was 7.8±1.0% in Pump and 7.9±1.2% in Inj (NS). SH occurred in 3.5% of Pump and 5.4% of Inj (P=0.053). DKA occurred in 2.7% of Pump and 2.7% of Inj. Overweight was present in 10.7% of Pump and 10.4% of Inj. Insulin dosage was 0.82±0.28 U/k.d in Pump and 0.95±0.29 U/k.d in Inj (P<2.10−16). Large expert centers had the same pump results than small centers (HbA1c 7.8±1% vs 7.8±1.0%).
Conclusion: In field conditions, insulin pump shows no clear superiority. The choice of this costly and more demanding mode of treatment should thus be balanced at the individual and public health level.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology