A Comparison of Continuous Subcutaneous Insulin Infusion vs. Multiple Daily Insulin Injection in Children with Type I Diabetes in Kuwait: Glycemic Control, Insulin Requirement, and BMI

Abstract

Objective: Continuous subcutaneous insulin infusion (CSII) and multiple daily insulin injections (MDI) are two methods currently used to manage type I diabetes mellitus (T1DM). Here we compare our experiences with CSII and MDI in a large cohort of pediatric patients in Kuwait.

Methods: Data on 326 patients with T1DM who were started on CSII between 2007 and 2012 were retrospectively compared with those of 326 patients on MDI. They were matched for sex, age at diagnosis, T1DM duration, glycemic control, insulin requirement, and body mass index (BMI). Data were collected at baseline and every three months and included glycated hemoglobin (HbA1c), insulin dose, and adverse events (severe hypoglycemia, diabetic ketoacidosis, and skin problems).

Results: The main reason for switching to CSII was to achieve better glycemic control (37%), followed by reducing hypoglycemia, and improving the quality of life (13.3% each). Although HbA1c decrease was most significant in the first year, it continued to be significantly lower in the CSII group compared to the MDI throughout the study period. Total daily insulin requirements were significantly lower in the CSII group. BMI increased in both groups, but the difference was significant only at the end of the fifth year. There was no significant change in the rate of diabetic ketoacidosis in either group. The CSII patients had more severe hypoglycemic episodes at baseline; however, it significantly decreased throughout the study period. Only five patients discontinued CSII therapy and two of these restarted within three months.

Conclusion: CSII is a safe intensive insulin therapy in youngsters with T1DM and achieved markedly fewer severe hypoglycemic episodes and lower daily insulin requirements.

Keywords: Adolescent; Body Mass Index; Child; Diabetes Mellitus, Type I; Hemoglobin A, Glycosylated; Insulin Infusion Systems.

Figure 1

Percentage of children who achieved the target of HbA_1c <7.5% at different time points during the five year follo-up.

Figure 2

HbA_1c levels in CSII and MDI groups from baseline to 60 months of follow-up. The drop in HbA1c was seen in both groups at six months; however, the drop was more significant in the CSII group throughout the follow-up period (p<0.001).

Figure 3

Mean HbA_1c values at baseline and throughout the five-year follow-up period stratified by age at pump insertion.

Figure 4

Mean HbA_1c values at baseline and throughout the five-year follow-up period stratified by duration of diabetes (years). Those who had a duration of diabetes 3–5 years had the best HbA1c improvement throughout the follow-up period.

Figure 5

Daily insulin requirement changes in both CSII and MDI groups. After an initial decrease in the first year, insulin requirements in the MDI group rose progressively, eventually exceeding the doses at baseline at the end of the fifth year

Figure 6

BMI changes in the CSII and MDI groups. Although the mean BMI z-scores increases were greater in the CSII group, the difference was statistically significant only at the end of the study.