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[IP] Insulin Pump Therapy from Diagnosis of Type 1 Diabetes - Results from the First



 <A
HREF="http://www.attendeeinteractive.com/shows/ada0302/index.cfm?fuseaction=L
ocator.PreviewAbstract&popup=yes&NoLayout=Yes&AbstractID=1003">63rd Scientific
Sessions</A>
Insulin Pump Therapy from Diagnosis of Type 1 Diabetes - Results from the
First 6 Months
 
Abstract Information
Abstract Number:    1903-PO
Authors:    NEESHA RAMCHANDANI, SVETLANA TEN, ABIGAIL I. KAMISHLIAN, HENRY
ANHALT, ANJLI KUKREJA, NOEL K. MACLAREN
Institution:    New York, NY; Brooklyn, NY
Results:    A growing experience indicates that continuous subcutaneous
insulin infusion (CSII) is the best available means of insulin replacement
therapy
for patients with type 1 diabetes (T1DM). CSII allows for an improved quality
of life compared to that obtainable using multiple daily injections (MDI) with
less risk of hypoglycemia. We hypothesized that initiation of CSII from time
of diagnosis of T1DM would be well-accepted by patients, would simplify
patient diabetes education over time, and could prolong the honeymoon period
by
preserving residual pancreatic beta cell function. Eighteen patients have been
enrolled in this study and started on CSII within the first month of diagnosis
to
date (average age at diagnosis = 13.6 + 6.8 yrs, 83.3% male, average duration
of MDI before starting pump = 2.2 + 1.4 weeks); 5 of these patients have
completed their first 6 months. A control group of patients on MDI who were
diagnosed with diabetes from 1997 onwards, obtained through chart review, were
used
as comparison (n=21, average age at diagnosis = 9.4 + 6.5 years, 52.4% male).
The two groups did not differ on age at diagnosis (p=0.055), baseline HbA1c
(CSII: 10.5 + 2.6%, MDI: 10.2 + 2.8%, p=0.74) or units/kg/day at diagnosis
(CSII: 0.59 + 0.27, MDI: 0.53 + 0.26, p=0.57). Whereas HbA1c values were
similar
and close to the normal range (CSII: 6.1 + 0.9%, MDI[n=14]: 6.4 + 1.0%,
p=0.48)
by 6 months after diagnosis, those on CSII required significantly less daily
exogenous insulin to achieve that value (CSII: 0.19 + 0.11 u/kg/day, MDI: 0.55
+ 0.27 u/kg/day, p=0.01). Furthermore, patients in the CSII group have
exhibited no attrition from the study, have had minimal hypoglycemia, and have
only
occasionally needed to give correction boluses (target BG = 120 mg/dl). Our
data thus far indicate that CSII is a feasible form of initial therapy for
T1DM
which allows for greater prolongation of the clinical honeymoon period of the
disease by 6 months after diagnosis. Further studies are required to determine
the longitudinal metabolic, complication, and psychosocial benefits of this
approach.
Category:   Clinical Therapeutics/New Technology
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