Insulin pump therapy in children and adolescents: improvements in key parameters of diabetes management including quality of life

• Published in: Diabetic medicine Vol. 22; no. 1; pp. 92 - 96
• Main Authors: McMahon, S. K., Airey, F. L., Marangou, D. A., McElwee, K. J., Carne, C. L., Clarey, A. J., Davis, E. A., Jones, T. W.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01-01-2005; Blackwell
• Subjects: Adolescent; adolescents; Adult; Biological and medical sciences; Child; Child, Preschool; children; Diabetes Mellitus, Type 1 - blood; Diabetes Mellitus, Type 1 - drug therapy; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Glycated Hemoglobin A - metabolism; Humans; hypoglycaemia; Hypoglycemia - drug therapy; Hypoglycemic Agents - administration & dosage; Infant; Insulin - administration & dosage; Insulin Infusion Systems; insulin pump therapy; Medical sciences; Quality of Life; Treatment Outcome; Endocrinopathy; Human; adolescents; hypoglycaemia; Diabetes mellitus; insulin pump therapy; Metabolic diseases; Hypoglycemia; Quality of life; Clinical management; Treatment; Insulin pump; children; Adolescent; Child
• DOI: 10.1111/j.1464-5491.2004.01359.x
• EISSN: 1464-5491
• ISSN: 0742-3071

Aims  To determine the impact of insulin pump therapy (continuous subcutaneous insulin infusion) on key parameters of diabetes management including quality of life in children and adolescents with Type 1 diabetes mellitus (T1DM).
Methods  All patients started on insulin pump therapy were prospectively followed before and after institution of insulin pump therapy. Data collected included age, duration of diabetes, glycated haemoglobin levels (HbA1c), anthropometric data and episodes of severe hypoglycaemia defined as hypoglycaemia resulting in coma or convulsion. A subset of patients also completed the Diabetes Quality of Life Instrument (DQOL) and Self‐Efficacy for Diabetes Scale (SED) questionnaires to assess quality of life.
Results  At the time of analysis, 100 patients had been managed with insulin pump therapy. The mean age when starting pump therapy was 12.5 (3.9–19.6) years. Duration of therapy ranged from 0.2 to 4.0 years (mean 1.4 years, median 1.5 years). HbA1c decreased from 8.3 ± 0.1% prior to pump therapy to 7.8 ± 0.1% (P < 0.0001). Episodes of severe hypoglycaemia decreased from 32.9 to 11.4 per 100 patient years. Components of quality of life measures showed improvement on pump treatment. BMI standard deviation scores (z scores) did not increase.
Conclusions  Pump therapy is proving an effective means of insulin therapy in the young patient that shows promise to improve glycaemic control with a reduction in hypoglycaemia frequency. Quality of Life measures suggest that psychosocial outcomes may be improved.