Pros and cons of insulin pumps highlighted in young type 1 diabetes patients
medwireNews: Continuous subcutaneous insulin infusion (CSII) therapy significantly lowers glycated hemoglobin (HbA1c) levels in young people with type 1 diabetes, but at the cost of an increased risk for diabetic ketoacidosis during the first year, UK researchers report.
They found that mean HbA1c decreased by 7.0 mmol/mol (0.6%) in 161 individuals with type 1 diabetes who initiated CSII in clinical practice at a median age of 11.9 years (range 1.1–17.6 years) and were followed up for a median of 2.3 years.
The median HbA1c value prior to CSII initiation was 75.0 mmol/mol (9.0%) compared with 67.0 mmol/mol (8.3%) during CSII.
Using a multilevel modeling approach that accounted for repeated data, the researchers observed significantly improved HbA1c for up to 4 years of CSII therapy, but by 7 years it had returned to pre-CSII levels.
Therefore, “the results suggest that there is a need for targeted support in maintaining HbA1c improvement for longer, especially during adolescence,” Trina Evans-Cheung (University of Leeds) and co-authors write in Diabetic Medicine.
The durability of HbA1c improvement differed between male and female participants: boys and men maintained reduced HbA1c levels for 6 years, compared with only 3 years in girls and women.
Females were also more likely to discontinue CSII therapy, with 22 stopping treatment, compared with eight males. While on CSII therapy, patients who ultimately discontinued had a mean HbA1c decrease of 5.0 mmol/mol (0.4%), which returned to pre-CSII start levels upon discontinuation.
Overall, hospital admissions for diabetic ketoacidosis increased more than threefold during CSII compared with before CSII initiation (7.4 vs 2.2 cases per 100 person–years).
However, further analysis revealed that this increase was isolated to the first year of CSII therapy. After this time, the rate was not significantly higher than that observed before CSII initiation.
There was no significant change in the rate of hypoglycemia during CSII compared with the pre-CSII period.
Evan-Cheung et al conclude that their findings “provide some insight into the patient groups most in need of targeted intervention” when initiating CSII therapy.
By Laura Cowen
medwireNews is an independent medical news service provided by Springer Healthcare. © 2018 Springer Healthcare part of the Springer Nature group