Ellen
01-15-2006, 03:09 PM
Diabetes Technology & Therapeutics
Insulin Pump Therapy in Preschool Children with Type 1 Diabetes Mellitus Improves Glycemic Control and Decreases Glucose Excursions and the Risk of Hypoglycemia
Dec 2005, Vol. 7, No. 6: 876-884
George S. Jeha, M.D. Pediatric Endocrinology and Metabolism Section, Texas Children's Hospital, Baylor College of Medicine.
Lefkothea P. Karaviti, M.D., Ph.D. Pediatric Endocrinology and Metabolism Section, Texas Children's Hospital, Baylor College of Medicine.
Barbara Anderson, Ph.D. Pediatric Endocrinology and Metabolism Section, Texas Children's Hospital, Baylor College of Medicine.
E. O'Brian Smith, Ph.D. The Children's Nutrition Research Center, Houston, Texas.
Susan Donaldson, R.N. Pediatric Endocrinology and Metabolism Section, Texas Children's Hospital, Baylor College of Medicine.
Toniean S. McGirk, R.N. Pediatric Endocrinology and Metabolism Section, Texas Children's Hospital, Baylor College of Medicine.
Morey W. Haymond, M.D. Pediatric Endocrinology and Metabolism Section, Texas Children's Hospital, Baylor College of Medicine.
The Children's Nutrition Research Center, Houston, Texas.
Background: Hypoglycemia in preschool children limits the effectiveness of insulin therapy. Continuous subcutaneous insulin infusion (CSII) is not widely used in this group.
Objectives: This study was designed (1) to test the hypothesis that compared with twice-daily insulin injection, CSII decreases the SD of the mean daily blood glucose (BG) and improves glycemic control and (2) to evaluate the effect of CSII on parental anxiety using the Parental Stress Index (PSI) scale.
Methods: Ten subjects <6 years of age and receiving insulin injections were recruited. Each underwent two 72-h CGMS® (Medtronic Minimed, Northridge, CA) monitoring periods and then was started on CSII and re-monitored 3 and 6 months later. We assessed the effects of CSII on the mean BG and SD of BG values, A1c, PSI scores, and number, distribution, and duration of hypoglycemic episodes.
Results: Pooled pre- and post-CSII data were compared. There was a 22% decrease in the BG variability (mean ± SD 93 ± 19 mg/dL vs. 72 ± 5 mg/dL; P = 0.02) and a 13% decrease in A1c (8.6 ± 0.8% vs. 7.5 ± 0.7%; P = 0.01). There was a decrease in the 24-h median number and duration of hypoglycemic episodes [1.16 vs. 0 episodes/24 h (P = 0.01) and 1.19 vs. 0.05 h/24 h (P = 0.01), respectively], as well as the median number and duration of nighttime episodes [0.83 vs. 0 episode/night (P = 0.008) and 0.98 vs. 0 h/night (P = 0.008), respectively]. We found no statistically significant change in the PSI score.
Conclusions: CSII in preschool children is feasible and safe. Pump therapy reduced the glycemic excursions and decreased hypoglycemia duration and frequency.
Insulin Pump Therapy in Preschool Children with Type 1 Diabetes Mellitus Improves Glycemic Control and Decreases Glucose Excursions and the Risk of Hypoglycemia
Dec 2005, Vol. 7, No. 6: 876-884
George S. Jeha, M.D. Pediatric Endocrinology and Metabolism Section, Texas Children's Hospital, Baylor College of Medicine.
Lefkothea P. Karaviti, M.D., Ph.D. Pediatric Endocrinology and Metabolism Section, Texas Children's Hospital, Baylor College of Medicine.
Barbara Anderson, Ph.D. Pediatric Endocrinology and Metabolism Section, Texas Children's Hospital, Baylor College of Medicine.
E. O'Brian Smith, Ph.D. The Children's Nutrition Research Center, Houston, Texas.
Susan Donaldson, R.N. Pediatric Endocrinology and Metabolism Section, Texas Children's Hospital, Baylor College of Medicine.
Toniean S. McGirk, R.N. Pediatric Endocrinology and Metabolism Section, Texas Children's Hospital, Baylor College of Medicine.
Morey W. Haymond, M.D. Pediatric Endocrinology and Metabolism Section, Texas Children's Hospital, Baylor College of Medicine.
The Children's Nutrition Research Center, Houston, Texas.
Background: Hypoglycemia in preschool children limits the effectiveness of insulin therapy. Continuous subcutaneous insulin infusion (CSII) is not widely used in this group.
Objectives: This study was designed (1) to test the hypothesis that compared with twice-daily insulin injection, CSII decreases the SD of the mean daily blood glucose (BG) and improves glycemic control and (2) to evaluate the effect of CSII on parental anxiety using the Parental Stress Index (PSI) scale.
Methods: Ten subjects <6 years of age and receiving insulin injections were recruited. Each underwent two 72-h CGMS® (Medtronic Minimed, Northridge, CA) monitoring periods and then was started on CSII and re-monitored 3 and 6 months later. We assessed the effects of CSII on the mean BG and SD of BG values, A1c, PSI scores, and number, distribution, and duration of hypoglycemic episodes.
Results: Pooled pre- and post-CSII data were compared. There was a 22% decrease in the BG variability (mean ± SD 93 ± 19 mg/dL vs. 72 ± 5 mg/dL; P = 0.02) and a 13% decrease in A1c (8.6 ± 0.8% vs. 7.5 ± 0.7%; P = 0.01). There was a decrease in the 24-h median number and duration of hypoglycemic episodes [1.16 vs. 0 episodes/24 h (P = 0.01) and 1.19 vs. 0.05 h/24 h (P = 0.01), respectively], as well as the median number and duration of nighttime episodes [0.83 vs. 0 episode/night (P = 0.008) and 0.98 vs. 0 h/night (P = 0.008), respectively]. We found no statistically significant change in the PSI score.
Conclusions: CSII in preschool children is feasible and safe. Pump therapy reduced the glycemic excursions and decreased hypoglycemia duration and frequency.