Background: Insulin pumps have been used for the management of type 1 diabetes for over 15 years in the west. However similar experience is lacking in India where multi dose insulin injections still form the mainstay of management of type 1 diabetes. In a first study of its kind from India, we attempt to highlight the effectiveness, safety and superiority of insulin pump use in type 1 diabetes.
Objective and hypotheses: To determine the impact of insulin pump therapy on short and long term glycaemic control, BMI, rate of severe hypoglycaemia and diabetic ketoacidosis (DKA) in children, adolescents and young adults.
Method: Retrospective analysis of data from case records of patients at our clinic. Out of the 64 patients on insulin pump, 52 were included in the study. Age of the patients at initiation of insulin pump ranged from 3 to 26 years. Data regarding pre-pump HbA1C (average HbA1C in the 6 months before starting insulin pump), pre-pump BMI (BMI at last visit before pump), pre-pump episodes of hypoglycaemia and DKA and post pump HbA1C (at 6 months and 1 year after pump initiation), post pump BMI (BMI at 6 months after pump) and post-pump episodes of hypoglycaemia and DKA (in the 1 year after pump) in each patient was recorded and compared.
Results: Of the 52 patients included, only 27 followed up for one year or more after initiation of pump and 25 had visits only up to 6 months. There was a drop in HbA1C and increase in BMI across all age groups with the maximum difference seen in the oldest age group after starting pump therapy. Only three episodes of DKA were recorded after pump therapy against ten episodes in the pre pump period. However there were three episodes of severe hypoglycaemia in the post pump period as compared to two episodes in the pre pump period (Table 1).
|Age group||No. of Pts. (52)||Duration of diabetes before starting on insulin pump (years)||Average pre-pump HbA1C (last HbA1C before pump)||Average pre-pump BMI (BMI at last visit before pump)||Average post-pump HbA1C (6 m) N=52||Average post-pump HbA1C (long term) (1 year) N=27||Post pump BMI (after 6 months of starting pump)|
|05 years||2||0.85 (0.251.5)||8.4||16.2||7.9 (0.5)||7.8 (0.6) N=2||16.3 (0.1)|
|610 years||16||2.75 (0.55)||8.0||16.3||7.8 (0.2)||7.7 (0.3) N=11||17.5 (1.2)|
|1115 years||20||4.3 (0.511)||9.0||17.8||7.6 (1.4)||7.6 (1.4) N=9||19.1 (1.3)|
|1620||10||5.6 (19)||9.2||21.2||7.6 (1.6)||8.0 (1.2) N=4||22.5 (1.3)|
|2125||4||10.7 (716)||9.5||19.7||8.0 (1.5)||8.0 (1.5) N=3||21.2 (1.5)|
Conclusion: This study suggests that insulin pump therapy is effective, safe and superior in children, adolescents and young adults with type 1 diabetes.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology