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[IP] Insulin pump therapy in toddlers and preschool children with type 1 diabetes mel

>Journal of Pediatrics Online</A>

Objective: To test whether glycemic control in young children could be
achieved more effectively and safely by using continuous insulin infusions
administered by insulin pumps.
Study design: We analyzed the effects of pump therapy in nine toddlers in
whom type 1 diabetes developed between the ages of 10 and 40 months. After a
mean of 13.7 months of therapy with multiple daily injections, patients were
treated with insulin pumps for periods ranging from 7 to 19 months (mean,
Results: Before initiation of pump therapy, HbA1c levels averaged 9.5% 1
0.4%, and patients had a mean of 0.52 episodes per month of severe
hypoglycemia (uncontrolled shaking, inconsolable crying, disorientation, or
seizures). After initiation of pump therapy, HbA1c levels declined to 7.9% 1
0.3% (P < .001 vs prepump levels), and the incidence of severe hypoglycemia
decreased to 0.09 episodes per month (P < .05). Normal linear growth and
weight gain were maintained during pump therapy. There were no changes in the
frequency of physician or emergency room visits for acute hyperglycemia or
ketoacidosis. However, the frequency of parental contacts with health
personnel declined by >80%, reflecting increasing parental confidence and
independence in diabetic care. Subjective assessments revealed significant
improvements in quality of life and high levels of satisfaction with pump
Conclusions: Insulin pump therapy may provide an effective alternative for
selected preschool children with type 1 diabetes. (J Pediatr 2002;141:490-5)
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