How Effective Is Insulin Pump Therapy in Youth With Type 1 Diabetes?

---

Age-specific advantages of continuous subcutaneous insulin infusion as compared with multiple daily injections in pediatric patients: one-year follow-up comparison by matched-pair analysis, by O. Kordonouri and colleagues. Diabetes Care 29:133–134, 2006.

What is the problem and what is known about it so far?

In recent years, treatment with continuous subcutaneous insulin infusion (CSII), or insulin pump therapy, has become more and more common in young people with type 1 diabetes. Some studies have shown that insulin pump therapy is better in the short term than normal insulin therapy, which requires multiple shots of insulin each day. Yet, there aren't many studies that have looked at the long-term effects of insulin pump therapy and whether it's better than normal insulin therapy.

Why did the researchers do this particular study?

An insulin pump delivers insulin continuously through a catheter placed under the skin. It is able to deliver very precise doses of insulin in a manner that mimics the normal insulin secretion of the body. Additional doses can be given during meal times with the push of a button. The pump has to be worn 24 hours a day, and the catheter is changed every 3 days.

The researchers of this study wanted to compare insulin pump therapy with normal therapy, which consists of multiple shots of insulin each day, for 1 year in young people who have type 1 diabetes.

Who was studied?

Fifty-two patients with type 1 diabetes who started insulin pump therapy between 2001 and 2004, and 52 patients who treated their type 1 diabetes with shots of insulin. The patients had been on their type of treatment for at least one year. About 60% of the patients were girls, and the average age was around 7 years.

How was the study done?

The patients who took insulin shots were given, on average, three to four shots a day, using a variety of different types of insulin. Patients in the insulin pump group used a short-acting insulin (see "For More Information" below for information about different types of insulin). The researchers then looked at the patients’ glucose levels, body weight (in relation to age and height), and how often the patients had severe hypoglycemia (when blood glucose levels become very low) and diabetic ketoacidosis.

Diabetic ketoacidosis is a serious condition in which very high blood glucose levels, along with a lack of insulin, force the body to break down fat for energy; this condition can lead to coma or death if not treated promptly.

What did the researchers find?

When the study began, the average A1C level (a measure of long-term blood glucose control) was 8.17% in both groups (see below for information on A1C). After six months, the A1C level of the patients who were on the insulin pump fell slightly to 8.02%; after 12 months, it increased to 8.27%. In the group who took shots of insulin, A1C rose to 8.41% after 6 months and to 8.51% after 12 months.

In patients who were younger than 12, the A1C level remained stable among those who were using the insulin pump; their A1C level was much lower than those who took the shots.

The amount of insulin required each day didn't change much among those on the pump; the amount increased among those who took shots.

Body weight didn't change much (in relation to their height and age) among those who were older than 12 and using the pump; it increased among those who were taking shots.

Hypoglycemia was slightly less frequent among those on the pump. Diabetic ketoacidosis occurred five times in the pump group and two times in the group who took shots.

What were the limitations of the study?

Patients who accept and take advantage of insulin pump therapy have their reasons for doing so. Some of these reasons have to do with clinical, behavioral, and psychological differences, and these differences weren't taken into account in this study.

Also, the patients on the insulin pump received more education and attention for several weeks than the patients who took shots.

What are the implications of the study?

For young children (less than 12 years old), insulin pump therapy appears to be more effective than multiple shot therapy at controlling blood glucose levels. However, intensified and repeated education is needed to prevent diabetic ketoacidosis in patients who use the insulin pump.

FOR MORE INFORMATION

Types of Insulin

A1C Test

ADA Guide to Raising a Child With Diabetes

2006 Resource Guide, A Supplement to Diabetes Forecast

Fast Fact Series: Playing the Numbers