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[IP] Pumps in kids, safe and successful

        Abstract #:
    Abstract Type:  Oral Abstract Presentation: Pediatric Diabetes, Insulin
Pumps and Quality Control Issues (10:15 - 12:15 PM)   
    Abstract Category:  Pediatrics    
    Pumps in Kids: Safe and Successful

    The present study was undertaken to compare the effect of Continuous
Subcutaneous Insulin Infusion (CSII) with that of insulin injections (II) in
young children ([lt]12 years)in a large pediatric diabetes program. We
retrospectively reviewed the charts to collect all data which had been
prospectively collected, including all patients who were started on the
insulin pump from 1/1/97 to 3/31/00. We initiated pump treatment on an
outpatient basis. The children and parents came into the center for a 1 hour
session to start the pump and returned 2 days later to change the site and
set up the pump on their own while being observed. The patients called the
day in between so that adjustments could be made in bolus doses and basal
rates. Blood glucose levels were obtained by the child or parent at the usual
times (before each meal and bedtime) and also at 12 midnight and 3AM. An
Advanced Practice Registered Nurse (APRN) started all patients and was on
call for them 24 hours/day. All patients were started on Humalog insulin
right from the start with no saline trial. Our primary endpoint was HbA1c
levels. Seventy-six schoolagers and 26 preschoolers have utilized pump
treatments for an average of 19.8 [plusminus] 8.6 months and
17.3[plusminus]6.5 months respectively. All but one have remained on CSII. As
shown in the table, most children were well controlled prior to starting CSII
yet had a statistically significant and clinically meaningful reduction in
HbA1c levels during the first 12 months. That reduction has been maintained
at the most recent visit. The risk of severe hypoglycemia was very low (0.2
events/pt/year). There were 2 episodes of DKA. One was due to a site
infection and the other to not taking bolus doses. There were some minor site
infections easily treated with antibiotics or warm soaks. The total daily
dose of insulin did not differ from II to CSII. We have demonstrated that
CSII is an effective and safe means of achieving treatment goals much closer
to normal than II in very young children in a large pediatric diabetes

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