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[IP] Abstract: CSII lower risk of hypo, improve...adolescents with type 1

1 : Diabetes Care 1999 Nov;22(11):1779-84
Continuous subcutaneous insulin infusion. A new way to lower risk of 
severe hypoglycemia, improve metabolic control, and enhance coping in 
adolescents with type 1 diabetes. 
Boland EA, Grey M, Oesterle A, Fredrickson L, Tamborlane WV 
Yale Children's Clinical Research Center, Yale University School of 
Nursing, New Haven, Connecticut, USA. email @ redacted
[Medline record in process]
OBJECTIVE: Recommendations from the Diabetes Control and Complications 
Trial (DCCT) indicate that adolescents with type 1 diabetes should be 
treated with intensive therapy involving multiple daily injections (MDI) 
of insulin or insulin pump therapy (continuous subcutaneous insulin 
infusion [CSII] to help obtain better metabolic control and prevent 
later complications. Interest has thus focused on insulin pump therapy 
to help adolescents meet this challenge. The purpose of this study was 
to examine responses to CSII and MDI in a large group of adolescents 
with established type 1 diabetes during a 12-month period and to 
determine whether either treatment regimen more favorably affected 
clinical and psychosocial outcomes. RESEARCH DESIGN AND METHODS: 
One-third of 75 youths aged 12-20 years who were candidates for 
intensive therapy chose CSII as their mode of treatment. Patients 
received intensive treatment and education as described by the DCCT 
investigators. Psychosocial data (e.g., quality of life, depression, 
self-efficacy, and coping) were collected at baseline and at 6-month 
intervals, and clinical data (e.g., HbA1c levels, adverse events) were 
collected every 4-6 weeks. RESULTS: Although both MDI- and CSII-treated 
adolescents initially exhibited improved metabolic control, this level 
of control was more difficult to sustain for 12 months in the MDI group 
(at 6 months HbA1c = 8.1, at 12 months HbA1c = 8.3), whereas average 
HbA1c levels in the CSII group continued to decrease during the 12 
months of treatment (at 6 months HbA1c = 7.7, at 12 months HbA1c = 7.5). 
Despite lower HbA1c levels in CSII-versus MDI-treated patients, the rate 
of severe hypoglycemic events was reduced by almost 50% in the CSII 
group (P = 0.01). Self-reported questionnaires demonstrated that there 
was improvement in self-efficacy, depression, and quality of life in 
both MDI- and CSII-treated patients. Finally, adolescents using CSII 
found coping with diabetes to be less difficult than adolescents using 
MDI did. CONCLUSIONS: CSII is an alternative means to lower HbA1c levels 
and reduce the risk of hypoglycemia without adversely affecting 
psychosocial outcomes in adolescents with type 1 diabetes. 
PMID: 10546007, UI: 20013330 
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