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[IP] CSII for children and adolescents in routine diabetes care

 <A HREF="http://www.diabetes.org/am2000/NumberResults.asp?idAbs=1516">60th 
Scientific Sessions Abstract Display for Abstract Number</A> 
Abstract #:
Abstract Type:  Publish Only 
Abstract Category: Clinical Diabetes: Therapeutics/New Technology 
Abstract Schedule: -,  

Continuous Subcutaneous Insulin Infusion (CSII) Therapy for Children and 
Adolescents in Routine Diabetes Care 

To date, reports of CSII use in the pediatric population have been confined 
largely to clinical research protocols. Subjects have been enrolled into 
intensified therapy studies following the DCCT model with frequent contact 
and visits. This report is the experience of a large pediatric diabetes 
center using CSII (with Humalog insulin) as a clinical tool in diabetes 
management. Fifty-six patients (aged 7-23 yr, mean=17  3.3 yr) were followed 
for at least 6 months on CSII therapy. Prior to and during CSII therapy, each 
patient was evaluated by the diabetes care team. Re-education in diabetes 
management skills was given as needed. The reasons for choosing CSII included 
failure to achieve desired metabolic goals, avoidance of hypoglycemia, 
improved diabetes lifestyle, and decreased frequency of injections. Following 
initiation of CSII, patients were seen after 1-4 weeks, then at 3 month 
intervals. Contact with the case manager occurred as felt clinically required 
by the patient. For the total cohort, the mean HbA1c changed from 8.5% 
(range: 6.0-11.5%) to 8.3% (range: 6.4%-11.8%), p=0.045. On CSII, 39% of 
patients demonstrated a significant decrease in HbA1c (8.4% to 7.6%, 
p<0.001), and 45% of patients maintained or achieved a HbA1c <8.0%. An 
additional 16% of patients achieved a HbA1c of 8.0-9.0% and at least a 1.0% 
decrease in their HbA1c. Six patients (10.6%) had a clinically significant 
increase in their HbA1c from 8.4% to 9.6%. Poor control resulted from 
repeated failure to administer bolus insulin doses. The rate of severe 
hypoglycemia (requiring assistance) was 12.3 vs. 9.5 events/100 patient-yr 
before and on CSII, respectively. There was a significant decrease in 
frequency of hypoglycemia (not requiring assistance) on CSII, with 41% of 
patients reporting fewer episodes vs. 18% reporting more episodes (p=0.035). 
Similarly, 18% of patients reported a decrease in seizure frequency vs. 2% 
reporting an increase on CSII (p=0.01). These results suggest that CSII is an 
effective alternative to insulin injection therapy in children and 
adolescents. Studies are underway to try to determine patient characteristics 
that may predict poor candidates for CSII therapy.
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