Continuous subcutaneous insulin infusion attenuated glycemic instability in preschool children with type 1 diabetes mellitus

Ramin Alemzadeh, Paola Palma-Sisto, M. Holzum, Elaine Parton, J. Kichler

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Abstract

Background/Aims: Continuous subcutaneous insulin infusion (CSII) is believed to decrease glycemic instability and hypoglycemia while increasing quality of life compared to insulin injection regimens. To evaluate indices of glycemic control and impact on quality of life, we studied a group of preschool children with type 1 diabetes mellitus (DM) on CSII. Methods: Fourteen patients (eight girls and six boys) 3.9 ± 0.8 years old with DM duration of 2.0 ± 0.8 years were transitioned from flexible multiple daily insulin (FMDI) (pre-meal aspart and bedtime glargine) to CSII. Patients were evaluated with hemoglobin A1c (HbA1c) and continuous glucose monitoring quarterly for 1 year. Mean blood glucose (MBG), mean amplitude of glycemic excursion (MAGE), and hypoglycemic events (blood glucose <60 mg/dL) were determined. Patients' parents completed quality of life [TNO-AZL Preschool Children Quality of Life (TAPQoL)] questionnaires for their children at baseline and 1.0 year. Results: The total daily insulin and the bolus:basal ratio did not change during CSII (0.72 ± 0.21 vs. 0.74 ± 0.16 U/kg/day and 2.1 ± 0.61 vs. 2.40 ± 0.58 U/kg/day, respectively). There was no change in HbA1c (8.0 ± 0.50% vs. 7.8 ± 0.40%) or frequency of hypoglycemia (moderate, 92.3 vs. 73.1 events/100 patient-years; severe, 22.5 vs. 17.5 events/100 patient-years). The MBG (213 ± 94 vs. 185 ± 79 mg/dL) and frequency (1.9 ± 1.6 vs. 2.1 ± 2.2) and duration (nocturnal, 135 ± 141 vs. 120 ± 103 min; total, 267 ± 222 vs. 189 ± 148 min) of hypoglycemic events did not decrease, whereas MAGE was reduced on CSII (210 ± 31 vs. 168 ± 22 mg/dL, P < 0.005). The quality of life subscales on the TAPQoL questionnaire did not change on CSII. Conclusions: CSII improved glycemic instability without reducing HbA1c or frequency and duration of hypoglycemic events and altering the parent's perception of his or her child's quality of life. CSII improves glycemic instability and is an effective alternative to FMDI therapy in young children with type 1 DM.

Original languageEnglish (US)
Pages (from-to)339-347
Number of pages9
JournalDiabetes Technology and Therapeutics
Volume9
Issue number4
DOIs
StatePublished - Sep 5 2007

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Subcutaneous Infusions
Preschool Children
Medical problems
Type 1 Diabetes Mellitus
Insulin
Quality of Life
Hypoglycemic Agents
Blood Glucose
Hemoglobins
Hypoglycemia
Parents
Glycemic Index
Meals
Diabetes Mellitus

All Science Journal Classification (ASJC) codes

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology
  • Medical Laboratory Technology

Cite this

Continuous subcutaneous insulin infusion attenuated glycemic instability in preschool children with type 1 diabetes mellitus. / Alemzadeh, Ramin; Palma-Sisto, Paola; Holzum, M.; Parton, Elaine; Kichler, J.

In: Diabetes Technology and Therapeutics, Vol. 9, No. 4, 05.09.2007, p. 339-347.

Research output: Contribution to journalArticle

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abstract = "Background/Aims: Continuous subcutaneous insulin infusion (CSII) is believed to decrease glycemic instability and hypoglycemia while increasing quality of life compared to insulin injection regimens. To evaluate indices of glycemic control and impact on quality of life, we studied a group of preschool children with type 1 diabetes mellitus (DM) on CSII. Methods: Fourteen patients (eight girls and six boys) 3.9 ± 0.8 years old with DM duration of 2.0 ± 0.8 years were transitioned from flexible multiple daily insulin (FMDI) (pre-meal aspart and bedtime glargine) to CSII. Patients were evaluated with hemoglobin A1c (HbA1c) and continuous glucose monitoring quarterly for 1 year. Mean blood glucose (MBG), mean amplitude of glycemic excursion (MAGE), and hypoglycemic events (blood glucose <60 mg/dL) were determined. Patients' parents completed quality of life [TNO-AZL Preschool Children Quality of Life (TAPQoL)] questionnaires for their children at baseline and 1.0 year. Results: The total daily insulin and the bolus:basal ratio did not change during CSII (0.72 ± 0.21 vs. 0.74 ± 0.16 U/kg/day and 2.1 ± 0.61 vs. 2.40 ± 0.58 U/kg/day, respectively). There was no change in HbA1c (8.0 ± 0.50{\%} vs. 7.8 ± 0.40{\%}) or frequency of hypoglycemia (moderate, 92.3 vs. 73.1 events/100 patient-years; severe, 22.5 vs. 17.5 events/100 patient-years). The MBG (213 ± 94 vs. 185 ± 79 mg/dL) and frequency (1.9 ± 1.6 vs. 2.1 ± 2.2) and duration (nocturnal, 135 ± 141 vs. 120 ± 103 min; total, 267 ± 222 vs. 189 ± 148 min) of hypoglycemic events did not decrease, whereas MAGE was reduced on CSII (210 ± 31 vs. 168 ± 22 mg/dL, P < 0.005). The quality of life subscales on the TAPQoL questionnaire did not change on CSII. Conclusions: CSII improved glycemic instability without reducing HbA1c or frequency and duration of hypoglycemic events and altering the parent's perception of his or her child's quality of life. CSII improves glycemic instability and is an effective alternative to FMDI therapy in young children with type 1 DM.",
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AU - Parton, Elaine

AU - Kichler, J.

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N2 - Background/Aims: Continuous subcutaneous insulin infusion (CSII) is believed to decrease glycemic instability and hypoglycemia while increasing quality of life compared to insulin injection regimens. To evaluate indices of glycemic control and impact on quality of life, we studied a group of preschool children with type 1 diabetes mellitus (DM) on CSII. Methods: Fourteen patients (eight girls and six boys) 3.9 ± 0.8 years old with DM duration of 2.0 ± 0.8 years were transitioned from flexible multiple daily insulin (FMDI) (pre-meal aspart and bedtime glargine) to CSII. Patients were evaluated with hemoglobin A1c (HbA1c) and continuous glucose monitoring quarterly for 1 year. Mean blood glucose (MBG), mean amplitude of glycemic excursion (MAGE), and hypoglycemic events (blood glucose <60 mg/dL) were determined. Patients' parents completed quality of life [TNO-AZL Preschool Children Quality of Life (TAPQoL)] questionnaires for their children at baseline and 1.0 year. Results: The total daily insulin and the bolus:basal ratio did not change during CSII (0.72 ± 0.21 vs. 0.74 ± 0.16 U/kg/day and 2.1 ± 0.61 vs. 2.40 ± 0.58 U/kg/day, respectively). There was no change in HbA1c (8.0 ± 0.50% vs. 7.8 ± 0.40%) or frequency of hypoglycemia (moderate, 92.3 vs. 73.1 events/100 patient-years; severe, 22.5 vs. 17.5 events/100 patient-years). The MBG (213 ± 94 vs. 185 ± 79 mg/dL) and frequency (1.9 ± 1.6 vs. 2.1 ± 2.2) and duration (nocturnal, 135 ± 141 vs. 120 ± 103 min; total, 267 ± 222 vs. 189 ± 148 min) of hypoglycemic events did not decrease, whereas MAGE was reduced on CSII (210 ± 31 vs. 168 ± 22 mg/dL, P < 0.005). The quality of life subscales on the TAPQoL questionnaire did not change on CSII. Conclusions: CSII improved glycemic instability without reducing HbA1c or frequency and duration of hypoglycemic events and altering the parent's perception of his or her child's quality of life. CSII improves glycemic instability and is an effective alternative to FMDI therapy in young children with type 1 DM.

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