Background: Early establishment of good metabolic control with intensive insulin therapy can reduce the incidence and delay the progression of complications in type 1 diabetes (T1D) mellitus.
Objective and hypotheses: To investigate the long-term outcomes of all children and adolescents started on continuous subcutaneous insulin infusion or pump therapy in our tertiary centre.
Method: All children with T1D who started on continuous subcutaneous insulin infusion (CSII) and had at least 12 months follow up data were included. Glycosylated haemoglobin (HbA1c) levels, insulin requirements, adverse events, and anthropometric data was collected pre CSII initiation, at 6 months follow up, and annually thereafter. Subgroup analysis was carried by age: ≤5 years old, 611.99 years old, and >12years old. Follow up data was obtained for 60% (38/63) of patients who had transitioned on to adult services.
Results: 209 children underwent pump initiation of which 185 patients (96 female) met inclusion criteria. Mean (SD) age at diagnosis was 6.0 (3.7) years; mean (SD) duration of diabetes was 8.1 (4.2) years; mean (SD) duration of CSII therapy was 4.86 (2.3) years (range 1.09.76 years). Mean (SD) HbA1c decreased from 8.75 (1.1) % pre-CSII, to 8.11 (0.84) % at year 1. HbA1c values at Years 27 post CSII were 8.08 (0.88) %, 8.12 (0.92) %, 8.12 (0.93) %, 8.32 (1.1) %, 8.28 (0.8) %, 8.2 (0.83) % respectively (P<0.001). Pre-schoolers and pre-adolescents had the greatest benefit in terms of HbA1c reduction. Mean BMI z-scores decreased during follow up (P=0.03). Severe hypoglycaemia and diabetic ketoacidosis rates were extremely low in the cohort and reduced from 2.3 to 0.7 and 4.7 to 0.86 per 100 patient-years post-CSII respectively.
Conclusion: CSII therapy is a safe and effective long-term treatment for management of T1D in children and adolescents. Use of sensor augmented CSII may offer additional benefits.
01 - 03 Oct 2015
European Society for Paediatric Endocrinology