Changes in Glycemic Control and Quality of Life in Pediatric Type 1 Diabetics with Continuous Subcutaneous Insulin Infusion of Insulin Aspart Following Multiple Daily Injection Therapy

Abstract

The efficacy of continuous subcutaneous insulin infusion (CSII) of the rapid-acting insulin analogue, insulin aspart, was evaluated in 26 patients with childhood-onset type 1 diabetes aged between 6 and 18 yr who had been on basal-bolus therapy (multiple daily injection (MDI) of regular human insulin or rapid-acting insulin and intermediate/long-acting insulin). The glycemic control in the patients was evaluated based on changes in the clinical parameters and the patient quality of life (QOL) was evaluated by using the insulin therapy-related QOL questionnaire. Twenty two patients continued CSII during the 6-mo study period. The mean HbA1c was 7.8 ± 1.8% at baseline and it decreased to 7.4 ± 0.8% at 6 mo after the start of the CSII. Overall, no decrease of the QOL post-CSII initiation was noted. The possible superiority of CSII as compared to MDI was suggested for patients who “eat out” or “have to look for an appropriate place for insulin injection.” Aside from an inadequate indwelling needle placement detected after the initiation of CSII in several patients, no adverse event associated with NovoRapid® was seen. In conclusion, CSII of rapid-acting insulin appears to be a useful therapy for patients with childhood-onset type 1 diabetes.

Two Cases With Type 1 Diabetes Treated With Insulin Pump Therapy Using a Telemedicine Approach During the COVID-19 Pandemic

“…Insulin pump therapy has mechanical procedure challenges and potential risks to users, resulting in unintended discontinuation of insulin due to kinking of the catheter and inappropriate syringe priming. Therefore, CSII is generally initiated during hospitalization in Japan to provide mechanical trouble education and careful titration of insulin doses [6], unlike other countries introducing it in outpatient settings. However, if subjects live in a place with barriers to healthcare access and elaborate follow-up, initiation of insulin pump therapy becomes difficult, especially during the COVID-19 pandemic.…”

“…Therefore, they could not attend to outpatients frequently and felt demotivated to introduce CSII by their circumstances. Thus, in Japan, the initiation of CSII has generally been performed on an inpatient basis for sufficient education and training in emergencies, unlike abroad [6].…”

Utility of an Increment in the Basal Rate during Mealtime in Place of Pre-meal Boluses for Preschool-aged Children with Type 1 Diabetes Using CSII

“…In Japan, CSII using an Ra has recently become an important strategy for intensive insulin therapy among children and adolescents with T1DM (7). The effectiveness of this new treatment in improving glycemic control and reducing the risk of severe hypoglycemia is more emphasized in preschool-aged children (1,2,3,4,5,6).…”

Insulin Aspart in the Management of Diabetes Mellitus: 15 Years of Clinical Experience

“…As shown in Table 5 , insulin aspart CSII has shown comparable safety to MDI therapy [ 98 , 112 , 113 , 116 , 117 ]. These results may appear somewhat at odds with those from a meta-analysis comparing CSII with MDI, which indicated a significantly greater risk of severe hypoglycemia with MDI compared with CSII (rate ratio 4.19 [95 % CI 2.86–6.13]) [ 158 ].…”