Background: This study evaluated the predictors of effectiveness and durability of insulin pump therapy in children and adolescents who have initiated continuous subcutaneous insulin infusion (CSII) within 2 years after the diagnosis of type 1 diabetes mellitus (T1DM). Subjects and Methods: The charts of individuals with T1DM using insulin pumps who were treated at our center were reviewed, including subjects with age at onset of <22 years, interval between onset and insulin pump commencement (interval onset-commencement) of <2 years, use of pumps of >1 year, and use of glucose sensors for <4 weeks/year. The primary end point was the mean glycosylated hemoglobin (HbA1c) value (MHbA1c) throughout the follow-up. Results: From 684 patients treated with insulin pumps, 119 met the inclusion criteria, and 113 were selected for statistical analysis (60 females; age at diabetes onset, 8.9 -5.6 years [mean -SD]; follow-up, 4.0 -1.8 years; range, 1-8 years; baseline HbA1c, 9.3 -1.8%). Only the interval onset-commencement was a linear predictor of the MHbA1c (P = 0.01; R 2 = 0.089). A significant reduction of the mean yearly HbA1c from baseline throughout all the follow-up was observed (P < 0.001). Categorizing the sample into four quartiles on the basis of an increasing interval onset-commencement resulted in levels of MHbA1c significantly lower in the first and second quartiles in comparison with the fourth quartile (7.6 -0.8% and 7.8 -1.0%, respectively, versus 8.5 -0.8%; P < 0.001 and P = 0.004, respectively). Conclusions: The present study suggests that early pump commencement in children and adolescents with T1DM provides lower and more durable HbA1c values than a late commencement. It is possible that an early pump commencement could prolong the honeymoon phase, but we cannot confirm or exclude this hypothesis because the lack of data about C-peptide levels during the follow-up.
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