Benefits of continuous subcutaneous insulin infusion in children with type 1 diabetes

Willi, Steven M.; Planton, Jonathan; Egede, Leonard E.; Schwarz, Sharon

doi:10.1067/s0022-3476(03)00579-1

Cited by 106 publications

(95 citation statements)

References 19 publications

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“…167,168 Several studies described intensive training/ education of participants and their families. 101,140,144,146,147,152,[154][155][156][157][158][159][160][161][162][164][165][166][170][171][172][173][174] Some training programmes included the use of a dummy saline pump. 154,157,158,171 Initiation of pump therapy involved a period of admission to clinic or hospital in a few studies.…”

Section: Education and Support For Csiimentioning

confidence: 99%

“…101,140,144,146,147,152,[154][155][156][157][158][159][160][161][162][164][165][166][170][171][172][173][174] Some training programmes included the use of a dummy saline pump. 154,157,158,171 Initiation of pump therapy involved a period of admission to clinic or hospital in a few studies. 152,158,171 Intensive ongoing support was often provided, including initial frequent visits and telephone contact, 152,156,158,161,165,166,172 and 24-hour nurse on call or telephone support.…”

Section: Education and Support For Csiimentioning

confidence: 99%

See 1 more Smart Citation

Clinical effectiveness and cost-effectiveness of continuous subcutaneous insulin infusion for diabetes: systematic review and economic evaluation

Cummins

Royle²,

Snaith³

et al. 2010

Health Technol Assess

184

155

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Section: Education and Support For Csiimentioning

confidence: 99%

Section: Education and Support For Csiimentioning

confidence: 99%

Clinical effectiveness and cost-effectiveness of continuous subcutaneous insulin infusion for diabetes: systematic review and economic evaluation

Cummins

Royle²,

Snaith³

et al. 2010

Health Technol Assess

184

155

View full text Add to dashboard Cite

show abstract

“…The advantages of CSII over multiple daily injections include increased lifestyle flexibility, variable basal infusion rates with boluses given before meals, and only one injection for insulin administration every few days (2). CSII in children lowers A1C and decreases hypoglycemia (3,4). The American Diabetes Association recommended A1C treatment goals for pediatric patients of 7.5-8.5% for those aged Ͻ6 years, Յ8% for those aged 6 -12 years, Ͻ7.5% for those aged 13-19 years, and Ͻ7% for those aged 19 -22 years (5), but few children and adolescents reach these goals.…”

mentioning

confidence: 99%

Factors Correlating With Improved A1C in Children Using Continuous Subcutaneous Insulin Infusion

McVean

Eickhoff²,

MacDonald³

2007

Diabetes Care

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The Diabetes Control and Complications Trial demonstrated that tight metabolic control in patients with type 1 diabetes reduces the risk of microvascular complications (1). Subsequently, the use of continuous subcutaneous insulin infusion (CSII) to achieve strict metabolic control increased exponentially. The advantages of CSII over multiple daily injections include increased lifestyle flexibility, variable basal infusion rates with boluses given before meals, and only one injection for insulin administration every few days (2). CSII in children lowers A1C and decreases hypoglycemia (3,4). The American Diabetes Association recommended A1C treatment goals for pediatric patients of 7.5-8.5% for those aged Ͻ6 years, Յ8% for those aged 6 -12 years, Ͻ7.5% for those aged 13-19 years, and Ͻ7% for those aged 19 -22 years (5), but few children and adolescents reach these goals. The reason for this remains unclear. We conducted this study to determine the percentage of children using CSII who reached their A1C goal and to identify differences between children who met their goal and those who did not. RESEARCH DESIGN ANDMETHODS -Medical records of all patients (aged 2-22 years, n ϭ 236) with type 1 diabetes for Ն1 year using CSII for Ն6 months who were followed at the University of Wisconsin pediatric diabetes clinic were reviewed. Data from the time of initiation of CSII were analyzed. Age, duration of diabetes, A1C before CSII initiation, duration of CSII use, number of visits to the diabetes clinic in the previous year, number of basal rates and catheter sites (arms, legs, buttocks, or abdomen), and days between catheter changes were evaluated. A1C was determined using the DCA 2000ϩ instrument (Bayer Diagnostics, Tarrytown, NY).Baseline A1C, age, days between catheter changes, number of visits to the diabetes clinic, and basal rates were summarized by standard descriptive statistics in terms of means, SDs, and ranges. Comparisons of outcome measures between children who did and did not reach their A1C goal at their last clinic visit were performed using a nonparametric Wilcoxon's rank-sum test. The comparisons of duration of diabetes and duration of CSII use between children who reached their A1C goal and those who did not were age adjusted by fitting ANCOVA models. Categorical variables were analyzed using 2 analysis. All data analyses were performed using SAS version 6.12. A two-sided significance level of 0.05 was used.RESULTS -The mean Ϯ SD age of the subjects was 14.5 Ϯ 3.9 years, the duration of diabetes was 6.8 Ϯ 3.7 years (range 1.0 -18.6), the duration of CSII use was 2.9 Ϯ 3.7 years (0.5-9.8), and the age at initiation of CSII was 11.7 Ϯ 3.5 years.We found that 38% of patients using CSII (90 of 236) met their A1C goal at their most recent clinic visit. Patients who met their goal were significantly younger, had a shorter duration of diabetes, had a lower A1C before CSII, and had more catheter sites. There were no significant differences regarding sex, number of visits to the diabetes clinic in the previous yea...

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“…Die Therapieanpassung an wechselnde Tagesabläufe oder bei instabiler Stoffwechsellage kann flexibler gestaltet werden als mit der ICT. Dies führt zu einer verbesserten Diabeteseinstellung und damit zu einer langfristig besseren Prognose (43)(44)(45). Die Vermeidung von schweren Hypoglykämien ist mit der CSII effektiver möglich als mit der ICT, dies gilt insbesondere für die Nachtverläufe.…”

Section: Vorteile Der Csiiunclassified

Insulin pump treatment in type 1 diabetes mellitus

Klinkert

Quester²

2004

Dtsch med Wochenschr

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ÜbersichtenDer Verlauf des Diabetes und seiner Folgekomplikationen bei einem Patienten hängt wesentlich von der Qualität der Stoffwechseleinstellung ab. In vielen Studien, herausragend in der DCCT (39,40,42), wurde dies nachgewiesen. Gegenüber der konventionellen Therapie zeigte sich die Überlegenheit der intensivierten Diabetestherapie mit ICT (intensivierte konventionelle Insulintherapie) oder CSII (kontinuierliche subkutane Insulin-Infusion). Entscheidender Vorteil der CSII ist die Möglich-keit der vollständigen Trennung und individuellen Steuerbarkeit von prandialer und basaler Insulinversorgung.Die Einführung der Insulinpumpentherapie in die Behandlung des Typ 1-Diabetes erfolgte 1977 (7). Damals galten ausgepräg-te Blutglukoseschwankungen, Dawn-Phänomen, unregelmäßi-ger Tagesablauf und der Wunsch nach Flexibilität sowie die optimale Stoffwechselführung in der Schwangerschaft als Indikationen. Hypoglykämieprobleme stellten eine Kontraindikation dar. Mit Verbesserung der Pumpentechnik, mehr Sicherheit und effizienterer Patientenschulung sind die Indikationen erweitert worden. In den 90er-Jahren sank die Rate akuter Hypoglykämi-en unter CSII. Gegenüber der ICT lässt sich die Stoffwechseleinstellung unter CSII verbessern und die Häufigkeit schwerer Hypoglykämien reduzieren (24, 44). Heute zählt die Hypoglykä-mieneigung zu den Hauptindikationen der Pumpentherapie. Bei Kindern und Jugendlichen wird die CSII seit 1979 eingesetzt, anfangs nur in Einzelfällen bei besonderen Problemen. Seit ca. 5 Jahren findet sie eine rasch zunehmende Verbreitung mit ähnli-chen Indikationen wie bei Erwachsenen (3,19,36,37,43,45). Aktuelle TechnikDurch konsequente Weiterentwicklung der Technik sind die heute eingesetzten Insulinpumpen klein, handlich, multifunktional, sicher und einfach zu bedienen (Abb.1).

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Benefits of continuous subcutaneous insulin infusion in children with type 1 diabetes

Cited by 106 publications

References 19 publications

Clinical effectiveness and cost-effectiveness of continuous subcutaneous insulin infusion for diabetes: systematic review and economic evaluation

Clinical effectiveness and cost-effectiveness of continuous subcutaneous insulin infusion for diabetes: systematic review and economic evaluation

Factors Correlating With Improved A1C in Children Using Continuous Subcutaneous Insulin Infusion

Insulin pump treatment in type 1 diabetes mellitus

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