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[IP] Transition from MDI to CSII in Pediatrics (abstract)

Abstract #:
Abstract Type:  Poster: Clinical Diabetes: Therapeutics/New Technology 
Abstract Category: Clinical Diabetes: Therapeutics/New Technology 
Abstract Schedule: 12:15 PM-2:15 PM, 6/12/2000  

Transition from Multiple Daily Injections (MDI) to Continuous Subcutaneous 
Insulin Infusion (CSII): Characteristics of a Pediatric Population 

The DCCT showed that tighter metabolic control of type 1 diabetes mellitus 
(DM) decreases the risk for long-term complications. CSII is a tool used to 
achieve this goal and is increasingly popular for children with DM. Although 
established for adults, few guidelines exist for the transition from MDI to 
CSII in children. Pubertal status, previous insulin regimen, and preceding 
glycemic control may all affect CSII insulin dose. The goal of this study was 
to evaluate the role of these factors in determining insulin doses at 
initiation of CSII. The study was a chart review of children who started CSII 
from 3/98 - 11/99. Data was collected from the pre-pump visit and 1st (at 1-2 
months) and 2nd visit on pump (at 3-6 months), and was analyzed using the 
Student's t-test. Forty-eight patients (13 pre-pubertal, 35 pubertal) were 
included. Age at pump start was 12  3.4 yrs, and duration of DM prior to 
pump start was 4.9  2.8 yrs. Pubertal patients had a decrease in their HbA1C 
compared to pre-pubertal patients at the 1st visit on CSII (-0.5  1 vs 0.3  
0.7%, p=0.01). Pubertal patients had a decrease in total insulin dose on 
CSII; pre-pubertal patients had little change (-0.3  0.3 vs 0.04  0.1 
u/kg/d, p=0.003). On CSII, the basal insulin dose was reduced ~40% compared 
to MDI basal dose, and comprised 45% of total insulin in both groups. Maximal 
basal rate in pre-pubertal patients occurred from 9pm - 12am and in pubertal 
patients from 3am - 9am and 9pm - 12am. Patients who had been on NPH and 
Ultralente did not differ from each other in change in total insulin or basal 
dose on CSII. Patients who had a pre-pump HbA1C >9 had a decrease of 0.7 in 
their HbA1C on CSII, while those with HbA1C 8-9 and <8 had minimal change. It 
is apparent that considerations for adults starting CSII do not necessarily 
apply to children. Pre-pubertal patients have a shift in the timing of 
maximal basal rate to late evening, and they require less of a decrease in 
their insulin dose compared to pubertal patients. Improved understanding of 
CSII dosing in children is necessary to ensure a better transition from MDI 
to CSII. Furthermore, understanding CSII dosing may lead to more 
physiological MDI regimens.
 <A HREF="http://www.diabetes.org/am2000/NumberResults.asp?idAbs=409">60th 
Scientific Sessions Abstract Display for Abstract Number</A> 
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