Background: There is limited knowledge in children younger than 6 years of age about the safety and efficacy of CSII treatment during long periods of time.
Objective and hypotheses: Evaluate the efficacy and safety of CSII treatment in pre-schoolers with T1D, assess if ISPAD/ADA criteria for good metabolic control are achieved and define general and specific characteristics of the treatment in this range of age.
Method: Charts of patients younger than 6 who started CSII treatment between 2003 and 2014 were reviewed. The cohort consisted of 27 patients (age 4 (2.94.7) years, 56% males). Age at start, T1D duration, HBA1c (HPLC, Menarini, normal value 5.1±0.31%), insulin dose, number of capillary blood glucose measurements (CBG), number of basal rates (BR) per day, % basal/total insulin (B/TI), insulin ratios at different meals, severe hypoglycaemia (SH episodes/100 patients years), DKA events, percentages of normoglycaemia (70180 mg/dl) and hypoglycaemia (<70 mg/dl) (N/H%), average glycemia and SD (GLSD) were analysed. Statistical analysis was performed by SPSS.
Results: HbA1c decreased to 6.8% in the first year. Afterwards, it remained under 6.8% during the follow-up (median 5 (36), range 19 years). Prior to CSII, 74% of children met ISPAD criteria. At one year, 96% had HbA1c <7.5%. CBG median per day was 10 (911). Total insulin dose did not change significantly. There was 1 episode of DKA and 1 episode of SH. Insulin needs at breakfast were higher (first year 0.92 vs 0.55, 0.6 and 0.5).
|Prior n=27||1y n=27||2y n=24||3y n=20||4y n=17||5y n=13|
|HbA1c||6.9 (6.77.5)||6.8 (6.47.1)*||6.6 (6.37)*||6.7 (6.26.9)*||6.6 (6.27.1)*||6.7 (6.27.1)*|
|(B/TI)||40 (3650)||29 (2442)*||34 (2944)||39 (2746)||37 (3045)||34 (2747)|
|BR||7 (68)||7.5 (68)||8 (79)||7 (78)||6.5 (57)|
Conclusion: CSII is effective and safe in pre-schoolers. It allows to achieve and maintain good metabolic control (based on ISPAD/ADA criteria) during long periods of time without increasing adverse effects.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology