Durability of Insulin Pump Use in Pediatric Patients With Type 1 Diabetes

Abstract

OBJECTIVE -To examine longitudinal outcomes, rate of and reasons for discontinuation, and predictors of insulin pump success in a cohort of youth initiating pump therapy.RESEARCH DESIGN AND METHODS -We followed a cohort of youth with type 1 diabetes (n ϭ 161) starting the pump between 1998 and 2001 and recorded natural history of treatment.RESULTS -At pump start, patients (71% female) had a mean age of 14.1 Ϯ 3.7 years, diabetes duration of 7.1 Ϯ 4.0 years, daily blood glucose monitoring (BGM) frequency of 4.0 Ϯ 1.2, a daily insulin dose of 1.0 Ϯ 0.3 units/kg, and an HbA 1c (A1C) of 8.4 Ϯ 1.4%. After 1 year, mean daily BGM frequency was 4.5 Ϯ 1.7, daily insulin dose was 0.8 Ϯ 0.2 units/kg, and A1C was 8.1 Ϯ 1.3% (all baseline versus 1-year data, P Ͻ 0.01). As of 2005, 29 patients (18%) had resumed injection therapy at a mean age of 17.0 Ϯ 2.9 years after a mean duration of pump use of 2.1 Ϯ 1.3 years. BGM frequency at baseline and at 1 year was significantly lower in the patients who resumed injection therapy (P Ͻ 0.02). In addition, patients who remained on the pump had lower A1C than those who resumed injection therapy at both 1 year (P ϭ 0.04) and at the most recent clinic visit (P ϭ 0.01).CONCLUSIONS -After an average of 3.8 years, Ͼ80% of pediatric patients maintained pump therapy with preservation of baseline A1C. Patients discontinuing the pump were less adherent and did not achieve equivalent glycemic benefit compared with continued users; these patients require ongoing support aimed at improving adherence and outcomes. Diabetes Care 29:2355-2360, 2006C ontinuous subcutaneous insulin infusion (CSII) is a safe and effective mode of insulin delivery in pediatric patients with type 1 diabetes. Several pump studies have demonstrated improved (1-5) or equivalent (6 -9) glycem i c c o n t r o l w i t h o u t i n c r e a s e d hypoglycemia (1)(2)(3)(4)(5)7,9) and with improved quality of life (2,7). Although there are several advantages of pump therapy in the pediatric population, barriers to success remain. Furthermore, pump discontinuation rates and reasons for discontinuation have not been well described in the pediatric literature.Health care providers strive to optimize glycemic control in patients with diabetes, and, given the benefits of pump therapy, they may consider CSII for most patients. In turn, treatment efforts should maximize success and intervene early for those individuals identified at risk for pump failure. Thus, we examined the demographic and diabetes-specific characteristics of a large group of pediatric patients with type 1 diabetes initiating pump therapy in order to determine the rate of and reasons for pump discontinuation. Next, we assessed the glycemic outcomes of those who maintained CSII therapy and those who resumed injection therapy. Finally, we compared patients who discontinued pump therapy with those who maintained pump therapy to further characterize the predictors of pump failure and identify opportunities for intervention. RESEARCH DESIGN ANDMETHODS -Participants were pati...

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

“…[138][139][140]144,149,151,154,155,157,[159][160][161][162][164][165][166]168,169,172,175,181 These are summarised in Table 17.…”

“…149,151,152,155,158,160,[166][167][168]171,173 One study 167 had no SH before or after going on pumps. Of the remaining 10 studies, the overall rate ratios varied from 0.12 to 0.80.…”

“…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.…”

The Use of Insulin Pumps in Youth with Type 1 Diabetes

“…Other criteria for initiation of insulin pump therapy in youth vary between centers. Rates of discontinuation of insulin pump therapy in youth, generally between 7% and 18% in the United States, 5,6 may relate to the rigidity of criteria for initiating treatment.…”

Insulin Pump Therapy: Its Effect on Metabolic Control in Different Age Groups in Children with Type 1 Diabetes

“…It is reported in the published long and short term observational studies that BMI was not increased, but even decreased, by the CSII treatment (2,16,17). When BMI values after CSII treatment were evaluated in our study, BMI SDS increase at the end of second year was statistically significant compared with baseline only in group 3 (10-15 years old) (from -0.21±0.67 to 0.46±0.60; p=0.00).…”