Effectiveness of Continuous Subcutaneous Insulin Infusion Pump Therapy During Five Years of Treatment on Metabolic Control in Children and Adolescents with Type 1 Diabetes Mellitus

Abstract

Objective:To compare continuous subcutaneous insulin infusion (CSII) therapy with multiple daily insulin (MDI) therapy on metabolic control in children and adolescents with type 1 diabetes mellitus (T1DM) over the long term.Methods:Fifty-two T1DM patients treated with CSII and monitored for at least one year prior to and at least five years following CSII were included. Thirty-eight age and sex-matched MDI controls with a 5-year follow up were recruited.Results:Mean age of the subjects, duration of diabetes and CSII therapy were 17.0±4.8 years, 10.7±2.8 years and 7.7±1.5 years respectively. Mean hemoglobin A1c (HbA1c) in the year prior to CSII, during the first year of treatment and after 5 years of CSII were 7.3±1% (56 mmol/mol), 7.0±0.7% (53 mmol/mol) and 7.8±1.3% (62 mmol/mol) respectively. Initial and 5-year mean HbA1C levels of controls were 7.9±1.08% and 8.6±1.8%. Mean HbA1c values were significantly lower in those receiving CSII therapy throughout follow-up. Basal and total insulin doses were significantly lower in the CSII group at all times. HbA1c was compared between subjects by age (0-5, 6-11 and 12-18 years) with no significant difference between them.Conclusion:Although CSII mean HbA1c values exceeded accepted good metabolic control limits after 5 years, CSII produces better HbA1c control at all times and in all age groups compared to MDI.

Clinical Outcome and Cost-Effectiveness Analysis of CSII Versus MDI in Children and Adolescent With Type 1 Diabetes Mellitus in a Public Health Care System of China

“…In a meta-analysis ( 16 ) comparing CSII vs. MDI demonstrated that HbA1c has a greater reduction in patients treated with CSII in all trials. In one study ( 17 ) over a 5 year follow up period, HbA1c levels, despite improving in the first 1 year, tended to increase over the subsequent 4-year period in CSII patients keeping with our findings. Furthermore, a recent comparative study by Karges et al ( 18 ) show that the use of CSII has better glycemic control during the most recent year of therapy.…”

Type 1 diabetes mellitus in children: experience in Indonesia

“…Previous studies showed that the benefits of CSII used include better glycemic control (15) and HbA1c level, less hypoglycemia events, and improved of insulin requirement. However, conventional therapy may still be applicable in developing countries such as in Indonesia (16,17).…”

Diabetes Melitus Tipe-1 pada Anak: Situasi di Indonesia dan Tata Laksana

“…14 Penggunaan CSII memperbaiki instabilitas glikemik, 15 kadar HbA1C, kejadian hipoglikemi, dan kebutuhan insulin. [16][17] Sayangnya, CSII belum tersedia secara luas di Indonesia. Berdasarkan data registri UKK Endokrinologi IDAI pada Oktober 2018, pengguna regimen insulin konvensional, intensif, dan CSII secara berturut-turut adalah 52,9%, 46,3%, dan 0,7%.…”

“…Rekomendasi IDAI dan ADA menargetkan <7,5%, 9,10 sementara ISPAD menetapkan patokan lebih rendah, yaitu <7%. 17 Data UKK Endokrinologi IDAI pada Oktober 2018 mendapatkan bahwa lebih dari setengah pasien (62,6%) memeriksakan HbA1C tiap tiga bulan, tetapi proporsi pasien yang tidak memeriksakan HbA1c secara rutin juga masih tinggi, yaitu 32,3%. 2 Pemantauan glukosa kontinu menggunakan alat minimal invasif yang dapat mengukur glukosa cairan interstisial subkutan setiap 1-5 menit.…”