Abstract
Studies indicate children and adolescents with Type 1 diabetes need treatment with multiple daily insulin injections (MDI) or subcutaneous insulin infusion (CSII) for glycemic control. This research study explored the efficacy of MDI’s compared to CSII therapy in children and adolescents with Type I diabetes in an urban setting by examining their HgbA1C outcomes. Retrospective chart review examined 58 records of children and adolescents (ages 0-21) in two outpatient settings who transitioned from MDI's to CSII. HgbA1c values were recorded during MDI use over one year and during the initial year of CSII use and the means were compared. The difference in mean HbA1c values during MDI and CSII therapies were tested using paired t-tests. HgbA1c values differed between age groups under and over 13. Reduction in mean HbA1c of 0.79 (p=0.02) in the older group was statistically significant. The change in the younger group of -0.09 (p=0.75) was not significant. Results suggest that children over 13 have improved glycemic outcomes using pump therapy. Nurses can build a long-term relationship with the patient and family, teaching self-management and offering choices of insulin administration as this study revealed that there was no difference in how they received insulin.
Highlights
Studies indicate children and adolescents with Type 1 diabetes need treatment with multiple daily insulin injections (MDI) or subcutaneous insulin infusion (CSII) for glycemic control
According to the Juvenile Diabetes Research Foundation (JDRF), as many as 1.25 million Americans are living with Type I Diabetes (T1D), including about 200,000 children and adolescents who are less than 20 years old
Recommendations from the landmark multisite studies, Diabetes Control and Complication Trial and the Epidemiology of Diabetes Interventions and Complications (EDIC) (1994-present), [1], indicate that adolescents with Type 1 diabetes should be treated with intensive therapy involving multiple daily insulin injections or insulin pump therapy to obtain better glycemic control and prevent later complications
Summary
The design of this study is retrospective, comparative and descriptive, using the medical records of 58 children and adolescents from two outpatient Diabetes Clinic, one located in a city hospital and one located in a state hospital in East Flatbush, Brooklyn, New York. The study was submitted to and approved by the Institutional Review Board of SUNY Downstate Medical Center. The population was drawn from the two clinics using specific inclusion criteria: age (under 22 years), length of time on MDI’s (minimum one year), and length of time on CSII (minimum one year). Demographic information collected included date of birth, gender, exact age at diagnosis, and age at transition from MDI’s to CSII. Race and ethnicity of the samples reflected the Caribbean and African populations of the neighborhood. Identifying information was not collected or linked with the coded participant
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