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

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_1с level changes over time were analysed before switching to CSII and were assessed depending on sex and age, baseline HbA_1с 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_1с value showed no significant changes as compared with the HbA_1с level before switching to CSII (baseline, 7.82±1.46%; final, 7.93±1.30%). Approximately 42% of patients had HbA_1с level of <7.5%. Better results were observed in the 4.5–7-year age group, where 67% of patients had HbA_1с level of <7.5%; in 12–18-year age group, only 35% of patients reached the target HbA_1с level. Majority of patients with baseline HbA_1с level of <7.5% remained within the target level during the final examination, whereas only 23% of patients with HbA_1с 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_1с 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_1с level, CGM use and frequency, and the presence or absence of changes in insulin therapy regimen is observed.

children, adolescents, type 1 diabetes mellitus, insulin pump, glycemia

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