Background: A large percentage of pediatric patients with type 1 diabetes (T1D) do not achieve their glycaemic targets. The most impactful benefit can be achieved by improving the implementation of novel technologies developed to manage diabetes.
Objective and hypotheses: Two novel technologies were introduced to help patients with T1D achieve glycaemic control: continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM). They were expected to change dramatically the method of treatment and improve patient quality of life (QOL). The aim was to evaluate the rate of use and the rate and reasons for discontinuation of these technologies in paediatric patients.
Method: We reviewed studies that included paediatric patients with T1D using CSII and CGM.
Results: The number of children treated with CSII has increased in most diabetic centres. CSII was found to lead to better glycaemic control, better health-related QOL, and decreased hypoglycaemic risk. Overall, the rate of CSII discontinuation has been relatively low. Factors associated with CSII discontinuation were lower frequency of self-blood glucose measurements (SBGM), higher HbA1c levels, older age at the time of CSII initiation, female gender, and decreased compliance. CGM was found to improve glycaemic control, especially when used >70% of the time. However, its rate of adoption has been relatively low. Its use was more likely in the presence of a higher frequency of SBGM, higher patient education, higher household income, and use of CSII.
Conclusion: While the hope for the development of a fully automated artificial pancreas remains, it is crucial to formulate effective approaches to implement the currently available technological advances, and ensure that their use is sustained. Lack of a proper education, diminished motivation, and behavioural attitude can affect patient compliance. Long-term follow-up with intensifying education and behavioural therapy accompanied by adequate training and ongoing support might improve adherence and enhance treatment satisfaction, leading to better glycaemic control.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology