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

Discussion in 'Insulin Pumps' started by Ellen, Mar 2, 2013.

  1. Ellen

    Ellen Senior Member

    Oct 22, 2005
    http://online.liebertpub.com/doi/pdfplus/10.1089/dia.2012.1221 ATTD 2013 Oral Presentations (Lots of interesting abstracts)

    J. Jager-Amsellem1, C. Hasselmann1, E. Perrodeau1, N. Faure1,
    I. Mercat1, F. Labarthe1, E. Bonnemaison2
    CHU Tours, 2
    Unite? de Spe?cialite?s Pe?diatriques, CHU Tours, Tours,
    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.
    Last edited: Mar 2, 2013
  2. denise3099

    denise3099 Approved members

    Jul 31, 2009
    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.
  3. selketine

    selketine Approved members

    Jan 4, 2006
    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.
  4. Tomdiorio

    Tomdiorio Approved members

    Jan 10, 2011
    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.
  5. missmakaliasmomma

    missmakaliasmomma Approved members

    May 31, 2013
    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.

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