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

• 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
• DOI: 10.1111/cen.12093
• EISSN: 1365-2265
• ISSN: 0300-0664

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.