[Assessment of metabolic control and safety of continuous subcutaneous insulin infusion in prepubertal children with type 1 diabetes mellitus]

Abstract

Background: Currently continuous subcutaneous insulin infusion (CSII) as a method of functional intensive insulin therapy is the most physiological way to administer insulin. In recent years treatment with insulin pumps has been used more frequently in the paediatric diabetes whereas application of this kind of therapy is relatively new in the youngest group of children below the age of 10 years. THE AIM of the study was to assess the efficiency of CSII by means of insulin pumps in prepubertal children with type 1 diabetes mellitus (T1DM).

Materials and methods: Three groups of T1DM children on intensive insulin therapy were compared. Group 1 comprised 30 children with CSII in the mean age 6.7+/-2.2 SD years (CSII-1). In group 2 were 25 children treated with multiple injections (MI-1) in the mean age 7.0+/-1.5 SD years and in group 3-35 children in the mean age 13.9+/-2.1 SD years treated with CSII (group CSII-2). The age of children was comparable in group CSII-1 and MI-1. T1DM duration was the same for all groups. After 6, 12, 18 months the following parameters were analyzed: HbA1c, daily insulin requirement (DIR) U/kg, number of severe hypoglycemic episodes and diabetic ketoacidosis (DKA).

Results: After 18 months in CSII-1 HbA1c decreased insignificantly from 7.1% to 6.9% and DIR was significantly reduced from 0.86 U/kg/24 h to 0.7 U/kg/24 h (after 6 months) and to 0,75 U/kg/24 h (after 12 months) and 0.77 U/kg/24 h after 18 months. In the MI-1 group HbA1c increased significantly from 7.0% to 7.4% in the 6th month and to 7.3% in the 18th month. DIR increased significantly from 0.68 U/kg/24 h to 0.76 U/kg/24 h; 0,8 U/kg/24 h and 0.84 U/kg/24 h after 6, 12, and 18 months respectively. There were no significant differences in HbA1c and DIR values in CSII-2 group after 18 months of observation. Significant difference of DIR was found in: CSII-1 vs. MI-1 and CSII-2 (p<0.05) in all study points. The highest number of severe hypoglycemic episodes and DKA was found in the MI-1 group.

Conclusion: CSII in T1DM children under 10 yrs of age provides good metabolic control, is associated with reduced insulin requirement and its safety is comparable to the older children treated with the same modality.