Original Articles
Insulin pump therapy in toddlers and preschool children with type 1 diabetes mellitus

https://doi.org/10.1067/mpd.2002.127500Get rights and content

Abstract

Objective: To test whether glycemic control in young children could be achieved more effectively and safely by using continuous insulin infusions administered by insulin pumps. Study design: We analyzed the effects of pump therapy in nine toddlers in whom type 1 diabetes developed between the ages of 10 and 40 months. After a mean of 13.7 months of therapy with multiple daily injections, patients were treated with insulin pumps for periods ranging from 7 to 19 months (mean, 12.7 months). Results: Before initiation of pump therapy, HbA1c levels averaged 9.5% ± 0.4%, and patients had a mean of 0.52 episodes per month of severe hypoglycemia (uncontrolled shaking, inconsolable crying, disorientation, or seizures). After initiation of pump therapy, HbA1c levels declined to 7.9% ± 0.3% (P <.001 vs prepump levels), and the incidence of severe hypoglycemia decreased to 0.09 episodes per month (P <.05). Normal linear growth and weight gain were maintained during pump therapy. There were no changes in the frequency of physician or emergency room visits for acute hyperglycemia or ketoacidosis. However, the frequency of parental contacts with health personnel declined by >80%, reflecting increasing parental confidence and independence in diabetic care. Subjective assessments revealed significant improvements in quality of life and high levels of satisfaction with pump therapy. Conclusions: Insulin pump therapy may provide an effective alternative for selected preschool children with type 1 diabetes. (J Pediatr 2002;141:490-5)

Section snippets

Patients

A total of 9 toddlers, younger than 4 years of age (5 boys,4 girls), were treated. All had classic type 1 diabetes and severe hyperglycemia and ketosis. The mean age of diagnosis of diabetes among study patients was 18.6 months (range, 10-40 months), whereas the mean age of initiation of pump therapy was 34.1 months (range, 20-58 months; Table).

Table. Characteristics of the study population( values are mean± SEM)

Empty CellStudy populationNot eligible
n (girls/boys)9 (4/5)19 (9/10)
Age of onset of diabetes

Patient characteristics

Among 28 infants, toddlers, and preschool children (<5 years of age) receiving care in the Duke pediatric diabetes clinic, there were a total of 9 patients who qualified for the study under the criteria used for selection (Table). Their mean age of diagnosis of diabetes was 18.6 ± 3.1 months (mean ± SEM). The study patients were treated with multiple daily injections for a mean of 13.7 ± 3.0 months. Pump therapy was initiated at a mean age of 34.1 ± 4.5 months (range, 20-58 months) and

Discussion

The objective of our study was to test the hypothesis that continuous insulin infusion14, 15, 16, 17, 18 could improve glycemic control in toddlers and preschool children with type 1 diabetes. The power of our study derives from the fact that we examined the effects of pump therapy in a group of patients who had been treated previously with multiple daily injections. Thus, each child served as his or her own control. This design has particular advantages, given the enormous individual and

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    Reprint requests: Michael Freemark, MD, Division of Pediatric Endocrinology and Diabetes, Box 3080, Duke University Medical Center, Durham NC 27710.

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