Continuous subcutaneous insulin infusion versus multiple daily injections in children at onset of ty

http://online.liebertpub.com/doi/pdfplus/10.1089/dia.2012.1221 ATTD 2013 Oral Presentations (Lots of interesting abstracts)

O-5
CONTINUOUS SUBCUTANEOUS INSULIN INFUSION
VERSUS MULTIPLE DAILY INJECTIONS IN CHILDREN
AT ONSET OF TYPE-1 DIABETES
J. Jager-Amsellem1, C. Hasselmann1, E. Perrodeau1, N. Faure1,
I. Mercat1, F. Labarthe1, E. Bonnemaison2
1
CHU Tours, 2
Unite? de Spe?cialite?s Pe?diatriques, CHU Tours, Tours,
France
Objective: Continuous subcutaneous insulin infusion (CSII)
has been used in children with diabetes for many years, but its
use at onset of diabetes has been little studied. Our aim was to
compare CSII started at onset of type-1 diabetes with multiple
daily injections (MDI) to assess metabolic control and safety.
Research design and methods: 41 children treated by CSII at
onset of diabetes ( January 2005?July 2009) were paired with 41
newly diagnosed children treated by MDI. They were paired by
age and gender. Data such as HbA1c, BMI, insulin requirement,
severe hypoglycemia, diabetic ketoacidosis and hospitalization
related to the diabetic condition, were recorded retrospectively
over a period of 18 months.
Results: The proportion of children with an HbA1c remaining
below 7.5% during the entire study was significantly greater in
the CSII group (43.3% vs. 8.7%). Insulin doses (IU/kg/d) were
lower in the CSII group after 1 year of treatment (0.6 vs. 0.71 IU/
kg/d). No difference was found regarding BMI, severe hypoglycemia or hospitalization. The length of the initial hospitalization was longer in the CSII group.
Conclusions: Our study suggests that the use of CSII, when
started at onset of type-1 diabetes, allows better metabolic control
than MDI and requires lower insulin doses. CSII appears as safe as
MDI regarding severe hypoglycemia and diabetic ketoacidosis.

 

Wow, nice. I guess this is a great argument against endos wanting to wait 6 mos or a year to allow kids to pump. Studies like these might lead to more ppl leaving the hospital pumping. Awesome.

 

I wish my pedi endo would have believed this back when William was first diagnosed. I asked her for a pump our first visit. The tiny doses of insulin he needed were just about impossible to give even with diluted insulin.

 

Very interesting. I would have suspected that, but scientific evidence is great. Hopefully endos will see this and give parents the option to choose at dx. But then again, maybe that is something parents don't need at the time of dx.

 

i have to somewhat agree with this. My daughter was diagnosed when she was 1 1/2 and we waited 3 years to put her on a pump. The only time she was hospitalized for dka was the initial diagnosis. Her a1C's I believe since then have always been below 7.5. Most recently 7.1 (she was still doing MDI then) Her endo said that she had very good sugars for doing injections and the only way it would get even better was going on the pump. We finally did decide on the pump (using it for about a month now) and I agree that it's better control of her sugar but in the beginning it's very difficult trying to get all the different ratios and basals down. It's quite a lot to do in the beginning, not to mention a lot more finger pricks.

My daughter is currently seeing her second endo ( we really did not like the first one she had) but they have both suggested the pump and say that they like newly diagnosed to be on it within a year. I personally think kids should be out of the "honeymoon" period before going on it bc of the risk of lows.