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[IP] young children with type 1 diabetes treated with continuous subcutaneous insulin

Endokrynol Diabetol Chor Przemiany Materii Wieku Rozw. 2003;9(1):11-5.  
[Metabolic control in young children with type 1 diabetes treated with 
continuous subcutaneous insulin infusion (insulin pump)]

[Article in Polish]

Pankowska E, Lipka M, Wysocka M, Szypowska A, Trippenbach-Dulska H, 
Czaplinska M, Kolodziejska B.

II Katedra Pediatrii Kliniki Diabetologii Dzieciecej i Wad Wrodzonych AM w 

Intensive insulin therapy is a method of choice in the management of patients 
with type 1 diabetes. Its administration in the youngest children is limited 
by little or no acceptance of multiple injections and a typical fear of 
needles and syringes. In recent years more and more frequently the method of 
multiple daily injections (MDI) of insulin is being replaced by the method of 
continuous subcutaneous insulin infusion (CSII) even in the youngest children. 
Objective: Evaluation of the safety and efficacy of CSII method in children at 
 prepubertal age. Material and methods: There were 61 children under 10 years of
with type 1 diabetes recruited for the study (33 boys, 28 girls). CSII method 
was implemented for the period of minimum 6 months. In the group of 21 
 children CSII method was the first method of their therapy (it was administered
the time of diagnosis). Mean duration of diabetes was 3.0 years +/-1.87 year, 
 mean age at diagnosis was 3.82+/-2.19 years and mean duration of CSII treatment
was 1.4 +/-0.75 year. The average HbA1c at the baseline for all children was 
8.7+/-1.4%. Results: In the group where CSII therapy was implemented as the 
 first method of management, mean duration of treatment was 1.5 years, mean
decreased after first 3 months from 9.6+/-1.68% to 7.22+/-0.99% (p<0.05). 
 After 12 and 24 months the value further decreased to 7.01+/-0.57%. In the
that was earlier treated with MDI method (n=40), mean value of HbA1c decreased 
after 3 months from 8.27+/-1.4% to 7.6 +/-0.86% (p<0.05), after 12 months it 
further decreased to 7.37+/-0.86%, after 24 months its mean value was 7.53%. 
The number of patients with HbA1c >8% decreased from 58.4% to 10%. Adverse 
events were observed only in the group that was earlier treated with the MDI 
 method. There were 3 incidences of severe hypoglycaemia, 2 incidences of
ketoacidosis, 2 incidences of infection at the needle site (in one case the 
surgical attention was necessary). After two years of the trial there was a 
 statistically significant difference in the mean value of HbA1c between
 that used CSII method from the moment of their diagnosis (HbA1c=7.01%) and
who were earlier treated with MDI method (HbA1c=7.53 +/-0.73%). In both 
groups the daily insulin requirement was similar (CSII method 0.69+/-0.2 
 unit/kg/day, MDI method 0.75+/-0.19 unit/kg/day) Conclusions: The method of
subcutaneous insulin infusion (CSII) provides good and sustained metabolic 
control in the youngest children with type 1 diabetes. Administering of that 
 method from the very beginning of the diabetes treatment may decrease the risk
acute complications.

PMID: 12831632 [PubMed - in process]    
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