Abstract
Aims
To evaluate the efficacy and safety of Continuous Subcutaneous Insulin Infusion (CSII)
in a pediatric cohort and to determine if the ISPAD/IDF/ADA criteria for good metabolic
control are achieved during long periods of time.
Methods
Retrospective longitudinal study including ninety patients [10.5 (6.5–13.9) years
of age, 58% males]. Age at debut, type 1 diabetes mellitus duration, pubertal stage,
HbA1c, insulin dose, mean number of glycemic controls, number of basal rates, % basal/total
insulin, severe hypoglycemia and diabetic ketoacidosis events were analyzed. Subgroup
analysis based on age and pubertal stage was performed.
Results
HbA1c decreased from 6.9% [52 mmol/mol] to 6.7% [50 mmol/mol] after one year of CSII. Afterwards, it remained less than 7% during the
follow-up period (median 3.5 ± 1.8 years (range 1–8). Prior to CSII, 76% of the subjects met ISPAD/ADA criteria.
One year after initiating CSII, 96% of children had HbA1c < 7.5%. Improvement in glycohemoglobin levels was most prominent in those patients with
the highest HbA1c initial levels. Total insulin dose decreased from 0.89 to 0.73 UI/kg/day
(p < 0.001). Proportion of basal/total insulin changed significantly (47 to 42% (p < 0.05)). Number of fractions of the basal rate increased from 5.6 ± 1.8 at one year of CSII to 6.7 ± 2.1 five years later. Incidence of severe hypoglycemic events decreased from 19 to
6.9 episodes/100 patient-year. Only 2 episodes of diabetic ketoacidosis occurred.
Conclusions
CSII allows reaching ISPAD/IDF/ADA goals safely during an extended follow-up period
in a diabetic pediatric cohort.
Keywords
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Article info
Publication history
Published online: February 01, 2016
Accepted:
January 8,
2016
Received in revised form:
January 8,
2016
Received:
November 11,
2015
Identification
Copyright
© 2016 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
