Insulinpumpe ved behandling av diabetes hos barn og unge

Abstract

The goals for metabolic control of children and adolescents with diabetes are stricter than previously. The purpose of the study was to compare two ways of administering insulin; i.e. multi-injection and continuous subcutaneous infusion, with respect to metabolic control and patient satisfaction. The study material consisted of all patients with type I diabetes, treated at the paediatric outpatient clinic, Innlandet Hospital Trust (Lillehammer), Norway in the period 1995 - 2004 (i.e. 5 years before and 5 years after insulin pumps became available). Patient information was retrieved from medical records and the Norwegian benchmarking study on paediatric diabetes (a national monitoring programme for children and adolescents with diabetes). Measures of disease control were glycosylated hemoglobin (HbA1c), incidence of ketoacidosis and severe hypoglycemia, and patient satisfaction in terms of patient preference. 80 patients were included in the study. Mean HbA1c was unchanged during the first 5-year period, but gradually decreased from 9.1 (SD 1.6 ) to 8.3 (SD 0.9) as the proportion of patients on continuous infusion increased. Mean HbA1c tended to be lower for pump users, but there was no change in the frequency of ketoacidosis or hospitalization due to hypoglycemia. 76 % of patients used an insulin pump at the end of the study. One patient reverted to multi-injections. The study suggests that insulin pumps compare well with multi-injections with respect to safety and disease control and that most children and adolescents prefer the pumps.