Background: A good metabolic control in preschool children with type 1 diabetes (DM1) is particularly challenging, being easier and safer with continuous subcutaneous insulin infusion (CSII) compared with multiple daily injections (MDI).
Objective and hypotheses: Evaluate and compare metabolic control of preschool children with DM1, before and 9 months after CSII therapy.
Method: Analytical retrospective study of children under the age of 6 when diagnosed with DM1 that began CSII therapy in 2013 first semester. Included variables: age at diagnosis and at CSII initiation, gender, insulin daily dose (IDD), mean blood glucose (previous14 days), A1c and mean percentage of hypo and hyperglycemia (previous 14 days). Variables were analyzed in the previous 3−3M) and after 3 (+3M), 6 (+6 M); and 9 (+9M) months of CSII initiation.
Results: Fourteen children were included, 57% male. Mean age at diagnosis was 2.7±1.3 years and mean age for CSII therapy initiation 5.1±1.7 years. Mean IDD remained constant: −3M (0.8±0.14 U/kg per day); +3M (0.75±0.17 U/kg per day, P=0.1); 6M (0.84±0.2 U/kg per day, P=0.44); and 9M (0.84±1.6, P=0.37). Mean blood glucose did not change significantly over time: −3M (159±27 mg/dl); +3M (163±27 mg/dl, P=0.6); +6M (165±18 mg/dl, P=0.4); and +9M (167±20 mg/dl, P=0.4). A1c levels decreased until 6M: −3M (7.1±0.6%); +3M (6.95±0.6%, P=0.37); +6M (6.87±0.4%, P=0.18); and +9M (7.04±0.6%, P=0.69). Hypoglycemia percentage decreased significantly over time: −3M (10.6±7.3%); +3M (5.9±4.1%, P=0.038); +6M (6.02±4.5%, P=0.026); and +9M (6.8±5.9%, P=0.05). There was no significant variation in hyperglycemia percentage: −3M (44.6±13.8%); +3M (44.3±14.4%, P=0.59); +6M (44.35±9.8%, P=0.95); and +9M (46.8±11.9, P=0.58).
Conclusion: With CSII the good metabolic control that already existed with MDI was kept. There was also a trend of decreasing in A1c, with significant reduction of hypoglycemia, that is particularly feared in this age group. Under close medical supervision and continuous education, CSII therapy allows to maintain good metabolic control, reducing hypoglycemia and providing improved quality of life.
20 - 22 Sep 2014
European Society for Paediatric Endocrinology