Glycaemic variability in paediatric patients with type 1 diabetes on continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI): a cross-sectional cohort study

Summary Objective This cross‐sectional observational cohort study was designed to investigate i) whether glycaemic variability in paediatric patients with type 1 diabetes is lower in those using an insulin pump (CSII) compared with those using multiple daily insulin injections (MDI) and ii) whether...

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Published in:	Clinical endocrinology (Oxford) Vol. 79; no. 5; pp. 641 - 647
Main Authors:	Schreiver, C., Jacoby, U., Watzer, B., Thomas, A., Haffner, D., Fischer, D.-C.
Format:	Journal Article
Language:	English
Published:	Oxford Blackwell Publishing Ltd 01-11-2013 Blackwell Wiley Subscription Services, Inc
Subjects:	Adolescent Biological and medical sciences Blood Glucose - drug effects Child Cross-Sectional Studies Diabetes Mellitus, Type 1 - blood Diabetes Mellitus, Type 1 - drug therapy Diabetes. Impaired glucose tolerance Drug Administration Schedule Endocrine pancreas. Apud cells (diseases) Endocrinopathies Etiopathogenesis. Screening. Investigations. Target tissue resistance Female Fundamental and applied biological sciences. Psychology General aspects Humans Infusions, Subcutaneous Injections Insulin - administration & dosage Insulin - therapeutic use Insulin Infusion Systems Male Medical sciences Vertebrates: endocrinology Endocrinopathy Human Immunopathology Multiple Variability Autoimmune disease Injection Daily Type 1 diabetes Insulin pump Cohort study Cross sectional study Child Endocrinology Glycemia Public health
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Summary:	Summary Objective This cross‐sectional observational cohort study was designed to investigate i) whether glycaemic variability in paediatric patients with type 1 diabetes is lower in those using an insulin pump (CSII) compared with those using multiple daily insulin injections (MDI) and ii) whether urinary F2‐isoprostanes and/or urinary prostaglandin F2 excretion as surrogate marker of oxidative stress and cyclooxygenase activity are associated with glycaemic variability. Methods 48 paediatric patients with type 1 diabetes (22 using an insulin pump) underwent an ambulatory 3‐day continuous glucose monitoring. All patients continued with normal daily activities and collected urine for two consecutive 24 h periods. The glucose pentagon was used to calculate the glycaemic risk parameter. Results Insulin requirements, HDL‐cholesterol, the mean of glycaemic excursions (P < 0·01) and the standard deviation of mean glucose concentration (P < 0·05) were significantly lower in patients with CSII compared with those using MDI. By contrast, averaged HbA1c during the last twelve months as well as at the time of sensor insertion did not differ significantly between both groups. Summarizing characteristic parameter of acute and long‐term metabolic control into the glucose pentagon revealed a significantly lower glycaemic risk parameter in CSI patients compared with both, healthy subjects and patients using MDI (P < 0·05). Conclusions Paediatric patients with type 1 diabetes using an insulin pump presented with lower glycaemic variability and a concomitantly lower glycaemic risk parameter compared with those using MDII. Whether these findings translate into a lower risk of diabetes associated cardiovascular complications remains to be elucidated.
Bibliography:	Medtronic, Meerbusch Germany ark:/67375/WNG-L1NQ5PV0-C ArticleID:CEN12093 istex:219FBA26F4B6FB74F968610CE68F9BA1EAB63172 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0300-0664 1365-2265
DOI:	10.1111/cen.12093