Continuous Subcutaneous Insulin Infusion and Sensor-Augmented Pump Therapy in Children and Adolescents

Abstract

Continuous subcutaneous insulin infusion (CSII) therapy is safe and effective in all age groups of type 1 diabetic patients. It may be elective therapy in neonatal diabetes and in preschool patients. Randomized trials in children and adolescents in CSII therapy have shown a significant improvement in treatment satisfaction without a substantial change in glycosylated hemoglobin A1c (HbA1c). Elevated levels of HbA1c not only at the start of CSII, but also during the follow-up, may be an important indicator of pump discontinuation. Sensor-augmented pump therapy (SAP) has a more beneficial effect in reducing HbA1c values, hyperglycemic excursions, and glycemic variability in children and adolescents with type 1 diabetes. Data on the safety and feasibility of SAP in preschool children have also been published. The low glucose suspend (LGS) function and its evolution, the predictive LGS, represent semiautomated processes able to prevent severe hypoglycemic events and extreme glucose fluctuations also in type 1 diabetes children and adolescents.