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[IP] CSII vs. MDI in Children

 Pediatrics. 2003 Sep;112(3):559-564. <A
Articles,</A> >Links</A>

Comparison of Continuous Subcutaneous Insulin Infusion and Multiple Daily 
 Injection Regimens in Children With Type 1 Diabetes: A Randomized Open

Weintrob N, Benzaquen H, Galatzer A, Shalitin S, Lazar L, Fayman G, Lilos P, 
Dickerman Z, Phillip M.

Institute for Endocrinology and Diabetes, National Center of Childhood 
Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel. 
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.

OBJECTIVE: To compare the efficacy and feasibility of continuous subcutaneous 
insulin infusion (CSII) with multiple daily insulin injections (MDI) in 
 children with type 1 diabetes. METHODS: The study sample included 23 children
males) aged 9.4 to 13.9 years with type 1 diabetes. An open randomized 
 crossover design was used to compare 3.5 months of CSII to 3.5 months of MDI
for the following variables: diabetic control, incidence of adverse events, 
 daily insulin requirement, body mass index standard deviation scores, treatment
satisfaction, and quality of life. RESULTS: The changes in HbA(1c) and 
 fructoseamine values were similar in the 2 arms over time. At the end of the
mean HbA(1c) level measured 8.05 +/- 0.78%. There were no differences between 
the treatment modes in frequency of symptomatic hypoglycemic or hyperglycemic 
events. There was 1 event of severe hypoglycemia during pump therapy and 3 
 during MDI, yielding a rate of 0.26 events per patient-year. There were no
of diabetic ketoacidosis. Body mass index standard deviation scores decreased 
during CSII and increased during MDI, as did mean insulin dose. Patients 
 expressed a higher treatment satisfaction from CSII than MDI, although there
no difference in quality of life between the 2 modes. CONCLUSIONS: Intensive 
insulin therapy by either insulin pump or MDI is safe in children and young 
adolescents with type 1 diabetes, with similar diabetes control and a very low 
 rate of adverse events. We suggest that both modes be available to the diabetic
team to better tailor therapy.    
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