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Systems of continuous subcutaneous insulin infusion to maintain metabolic compensation for type 1 diabetes mellitus among children and adolescents

https://doi.org/10.14341/DM10208

Abstract

BACKGROUND: Insulin pumps (IP) are a widespread treatment for type 1 diabetes mellitus (T1D) in children because of its several advantages over multiple insulin injection regimens (MII). However, the long-term effectiveness of continuous subcutaneous insulin infusion (CSII) in achieving and maintaining sustained metabolic compensation remains controversial.


OBJECTIVE: To determine the factors affecting the long-team effectiveness of CSII in children and adolescents with T1DM in real clinical practice.


METHODS: Data of 239 children and adolescents treated with CSII for ≥3 years were examined during the registration of patients receiving insulin pump therapy in Saint-Petersburg was formed. HbA level changes over time were analysed before switching to CSII and were assessed depending on sex and age, baseline HbA level and factors as the frequency of using continuous glucose monitoring (CGM), temporary transitions from CSII to MII with injection pens and use of bolus calculators (BC).


RESULTS: The final HbA value showed no significant changes as compared with the HbA level before switching to CSII (baseline, 7.82±1.46%; final, 7.93±1.30%). Approximately 42% of patients had HbA level of <7.5%. Better results were observed in the 4.5–7-year age group, where 67% of patients had HbA level of <7.5%; in 12–18-year age group, only 35% of patients reached the target HbAlevel. Majority of patients with baseline HbA level of <7.5% remained within the target level during the final examination, whereas only 23% of patients with HbA level of ≥7.5% before switching to CSII reached the target level. Better glycaemic control was also observed in patients treated with CSII regularly, as compared to patients who periodically switched to MII with the injection pen (p<0.05). HbA appeared to be lower in the group of 12–18-year-old adolescents who used CGM regularly, as compared to the group not treated with CGM (p<0.05).


CONCLUSION: Children and adolescents treated with CSII for ≥3 years did not experience a significant improvement in metabolic control. However, the influence of factors in maintaining the metabolic control, such factors as the patient’s age, initial HbA level, CGM use and frequency, and the presence or absence of changes in insulin therapy regimen is observed.

About the Authors

Elena B. Bashnina
North-Western State Medical University named after I.I Mechnikov
Russian Federation

MD, PhD, Professor



Irina M. Tsargasova
North-Western State Medical University named after I.I Mechnikov
Russian Federation

Graduate Student, Department of Endocrinology named after Academician V.G. Baranov



Olga A. Klitsenko
North-Western State Medical University named after I.I Mechnikov

Assistant professor, Department of Endocrinology named after Academician V.G. Baranov



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Supplementary files

1. Fig. 1. Dynamics of HbA1c concentration in children of different age groups (4.5–7 years old, 8–11 years old, 12–18 years old) receiving continuous subcutaneous insulin infusion for 3 years or more.
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2. Fig. 2. Dynamics of HbA1c concentration depending on its initial level.
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3. Fig. 3. The dynamics of changes in the concentration of HbA1c depending on its level until the transition to continuous subcutaneous infusion of insulin.
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4. Fig. 4. The dynamics of the concentration of HbA1c in different age groups depending on the constancy of the use of an insulin pump.
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5. Fig. 5. The dynamics of the concentration of HbA1c in the age group of 12-18 years, depending on the frequency of continuous monitoring of glucose.
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Review

For citations:


Bashnina E.B., Tsargasova I.M., Klitsenko O.A. Systems of continuous subcutaneous insulin infusion to maintain metabolic compensation for type 1 diabetes mellitus among children and adolescents. Diabetes mellitus. 2019;22(6):550-558. (In Russ.) https://doi.org/10.14341/DM10208

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ISSN 2072-0351 (Print)
ISSN 2072-0378 (Online)