Documento de consenso sobre tratamiento con infusión subcutánea continua de insulina de la diabetes tipo 1 en la edad pediátrica

Use of continuous subcutaneous insulin infusion in children and adolescents with type 1 diabetes mellitus: a systematic mapping review

“…Nine studies concluded that the use of CSII reduced hypoglycemic episodes [ 17 , 22 , 49 , 53 , 55 , 61 , 70 , 74 , 84 ] and 11 reported that there was a reduction in severe hypoglycemic episodes [ 12 , 13 , 34 , 49 , 52 , 64 , 66 , 71 , 72 , 75 , 77 ]. Three studies described a lower occurrence of nocturnal hypoglycemic episodes [ 31 , 37 , 74 ] and another described a decrease in morning hypoglycemic episodes [ 89 ].…”

“…In 13 studies, the risk of DKA, even when using CSII, was highlighted [ 13 , 16 , 17 , 22 , 23 , 27 , 30 , 49 , 52 , 72 , 92 , 97 , 98 ]. The occurrence of DKA episodes can be justified by the use of only fast-acting insulin in CSII [ 17 ].…”

“…This is possible because, with CSII, the configuration of basal doses can vary according to the insulin requirement of the child and adolescent [ 34 ]. Improvement in quality of life and / or satisfaction with treatment [ 13 , 16 , 17 , 23 , 28 , 32 , 37 , 52 , 56 , 57 , 66 , 69 , 75 , 77 , 113 ]. One study [ 65 ] showed a significant improvement in quality of life related to T1DM after the transition to CSII, but there was no improvement in generic quality of life.…”

“…The studies grouped together in this category show results that contribute to the understanding of the potential challenges of using CSII, with a view to the adequate management of T1DM. The challenges of using CSII found in this review were: The complexity of using CSII has been described as a challenge in two studies [ 25 , 59 ]; Eight studies highlighted the high economic cost of this technology [ 10 , 14 , 19 , 20 , 26 , 37 , 52 , 115 ]. In addition, when calculating costs related to treatment with CSII, the time spent on intensive training for family members by the team of diabetes educators and doctors should be considered, in addition to the daily adjustments of insulin doses made by physicians [ 14 ]; The lack of adherence by both parents, children and adolescents in the treatment using CSII was mentioned in 14 studies as being a challenge [ 10 , 36 , 80 , 114 , 116 – 125 ].…”

“…Eight studies highlighted the high economic cost of this technology [ 10 , 14 , 19 , 20 , 26 , 37 , 52 , 115 ]. In addition, when calculating costs related to treatment with CSII, the time spent on intensive training for family members by the team of diabetes educators and doctors should be considered, in addition to the daily adjustments of insulin doses made by physicians [ 14 ];…”