Insulin Pump in Young Children with Diabetes

Abstract

Endocrinology| December 01 2005 Insulin Pump in Young Children with Diabetes AAP Grand Rounds (2005) 14 (6): 68. https://doi.org/10.1542/gr.14-6-68 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Insulin Pump in Young Children with Diabetes. AAP Grand Rounds December 2005; 14 (6): 68. https://doi.org/10.1542/gr.14-6-68 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: diabetes mellitus, insulin infusion systems Source: Fox LA, Buckloh LM, Smith SD, et al. A randomized controlled trial of insulin pump therapy in young children with type 1 diabetes. Diabetes Care. 2005;28:1277–1281. In infants and toddlers with type 1 diabetes, achieving tight control of blood glucose is challenging. Investigators from Nemours Children’s Clinic in Jacksonville, Fla., randomized children aged 1 to 6 years with type 1 diabetes into 2 groups to compare glycemic control and impact on family life between children receiving traditional insulin injections and those receiving insulin by pump. Children in the injection group received 2 or 3 daily shots of long-acting insulin (NPH) and rapid-acting insulin analog. The pump group received continuous subcutaneous insulin infusion therapy. Both groups were monitored for mean blood glucose, hypoglycemia frequency, diabetes-related quality of life (QOL), parental adjustment, and changes in hemoglobin A1C. This study reports findings for a 6-month treatment period. Eleven children from each group completed the 6 months of study treatment; mean age was 46 months. At baseline, there were no significant differences between the 2 groups for hemoglobin A1C, age, sex, diabetes duration, parental quality of life, or mean blood glucose. Mean hemoglobin A1C and mean blood glucose levels did not change from baseline to 6 months in either group. The frequency of ketoacidosis, severe hypoglycemia, and hospitalizations were similar between the 2 groups throughout the study. Children on the insulin pump had more fasting and pre-dinner mild to moderate hypoglycemia at 1 and 6 months. Overall, diabetes-related QOL did not differ significantly between the 2 groups at the end of study. The authors conclude that the insulin pump is safe and well-tolerated in young children with diabetes and may have positive effects on QOL. However, the insulin pump did not improve diabetes control when compared to insulin injections. The benefits and expectations of pump therapy should be reviewed thoroughly before starting treatment in very young children, the authors suggest. Dr. Varma has disclosed no financial relationships relevant to this commentary. These authors studied the use of the insulin pump in young children with type 1 diabetes for only 6 months. Such a short study period precludes looking at complications that might occur with extended use of the pump; eg, could problems arise because the patient or playmates might disturb pump function by playing with it or pulling on it? On the other hand, this study does not show any advantage of the insulin pump for diabetes control, frequency of hypoglycemia, or other diabetes-related complications. While mothers in the injection group reported a greater impact of diabetes on the family at baseline, there were no differences between the mothers in the 2 groups at the end of the study. Fathers in the injection group reported more psychological distress than fathers in the pump group at the start of the study, but no significant difference existed at the end. No differences on the pediatric diabetes QOL scale were noted at any time during the... You do not currently have access to this content.