Abstract
The occurrence of hypoglycemia and hyperglycemia during the first days after transition to continuous subcutaneous insulin infusion (CSII) in patients with type 1 diabetes has not been systematically studied in children. The aim of this prospective study was to demonstrate that the protocol applied in our diabetes clinic is safe at CSII initiation in children. We assessed 22 pediatric patients with type 1 diabetes, using continuous glucose monitoring (CGM) before and after CSII initiation (±3 days). After CSII initiation, there was no difference in the rates of hypoglycemic events expressed as relative rates (RRs) per person-reading (RR = 0.85, p = 0.52, 95% CI 0.52-1.39), as well as in the number of prolonged hypoglycemic events (>1 h) per day (RR = 1.12, p = 0.56, 95% CI 0.75-1.68). We observed only a trend toward prolonged episodes of hyperglycemia after pump initiation (RR = 1.52, p = 0.06, 95% CI 0.97-2.35). Our study is the first to assess, through CGM and in a prospective way, the impact of a CSII initiation protocol on glycemic values. Our protocol provides a safe model to avoid hypoglycemia at CSII initiation in children. www.ClinicalTrials.gov, identifier NCT01840358.
Highlights
Continuous subcutaneous insulin infusion (CSII) is a highly accurate and flexible tool for administration of insulin
An increasing number of patients with type 1 diabetes mellitus (T1DM) under insulin injections will switch to CSII treatment during childhood [10]
We aimed to explore the interaction of potential confounders [age, sex, body mass index (BMI), duration of T1DM, total daily insulin (TDI), HbA1c, and type of insulin regimen before CSII]
Summary
Continuous subcutaneous insulin infusion (CSII) is a highly accurate and flexible tool for administration of insulin. When transitioning to CSII, the medical team programs manually the initial parameters, according to the total daily insulin (TDI) dose and the current metabolic control of the patient. The medical team adjusts the CSII parameters to reach an optimal glycemic control. The occurrence of hypoglycemia and hyperglycemia during the first days after transition to continuous subcutaneous insulin infusion (CSII) in patients with type 1 diabetes has not been systematically studied in children. The aim of this prospective study was to demonstrate that the protocol applied in our diabetes clinic is safe at CSII initiation in children
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