A randomized prospective study of insulin pump vs. insulin injection therapy in very young children with type 1 diabetes: 12-month glycemic, BMI, and neurocognitive outcomes

Zeina Nabhan, Nerissa C. Kreher, Dennis M. Greene, Erica Eugster, William Kronenberger, Linda DiMeglio

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Objective: To compare glycemic control, body mass index (BMI), neurocognitive function, and parenting stress for preschool-aged diabetic children randomized to treatment either with continuous subcutaneous insulin infusion (CSII) or with intensive insulin injection therapy (IIT). Methods: Children <5 yr of age diagnosed with type 1 diabetes mellitus for at least 12 months were randomized to either CSII (n = 21) or IIT (n = 21) for 6 months. After 6 months, the IIT group began CSII therapy and the CSII group continued on pumps. Hemoglobin A1c (HbA1c) and BMI percent were collected at baseline, 3, 6, 9, and 12 months. Neurocognitive assessments (Developmental Test of Visual-Motor Integration and Stanford-Binet Intelligence Scale: Fourth Edition) were administered to children, and parenting and child behavior assessments (Parenting Stress Index and Child Behavior Checklist) were completed by parents and at baseline, 6, and 12 months. Results: Thirty-five children completed the study. Mean HbA1c decreased significantly over the study period (8.9% ± 0.6 vs. 8.5% ± 0.7, p = 0.006). Initiation of CSII resulted in an HbA1c decrease of 0.4% after 3 months (p = 0.002); however, in the CSII first group, the HbA1c at 12 months was not significantly different from study start (8.8% ± 0.6 vs. 8.5% ± 0.6; p = 0.4). There were no significant changes in BMI%, neurocognitive, parenting, and child behavior measures between groups. Conclusion: Initiation of CSII vs. continuing IIT does not significantly influence HbA1c, BMI, neurocognitive, or parenting stress parameters in a research study setting.

Original languageEnglish
Pages (from-to)202-208
Number of pages7
JournalPediatric Diabetes
Volume10
Issue number3
DOIs
StatePublished - 2009

Fingerprint

Type 1 Diabetes Mellitus
Subcutaneous Infusions
Body Mass Index
Prospective Studies
Insulin
Injections
Parenting
Hemoglobins
Child Behavior
Therapeutics
Group Psychotherapy
Checklist
Intelligence
Parents

Keywords

  • Gycemic control
  • Insulin pump therapy
  • Neurocognitive function
  • Parental stress
  • T1DM
  • Toddlers

ASJC Scopus subject areas

  • Internal Medicine
  • Pediatrics, Perinatology, and Child Health
  • Endocrinology, Diabetes and Metabolism

Cite this

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title = "A randomized prospective study of insulin pump vs. insulin injection therapy in very young children with type 1 diabetes: 12-month glycemic, BMI, and neurocognitive outcomes",
abstract = "Objective: To compare glycemic control, body mass index (BMI), neurocognitive function, and parenting stress for preschool-aged diabetic children randomized to treatment either with continuous subcutaneous insulin infusion (CSII) or with intensive insulin injection therapy (IIT). Methods: Children <5 yr of age diagnosed with type 1 diabetes mellitus for at least 12 months were randomized to either CSII (n = 21) or IIT (n = 21) for 6 months. After 6 months, the IIT group began CSII therapy and the CSII group continued on pumps. Hemoglobin A1c (HbA1c) and BMI percent were collected at baseline, 3, 6, 9, and 12 months. Neurocognitive assessments (Developmental Test of Visual-Motor Integration and Stanford-Binet Intelligence Scale: Fourth Edition) were administered to children, and parenting and child behavior assessments (Parenting Stress Index and Child Behavior Checklist) were completed by parents and at baseline, 6, and 12 months. Results: Thirty-five children completed the study. Mean HbA1c decreased significantly over the study period (8.9{\%} ± 0.6 vs. 8.5{\%} ± 0.7, p = 0.006). Initiation of CSII resulted in an HbA1c decrease of 0.4{\%} after 3 months (p = 0.002); however, in the CSII first group, the HbA1c at 12 months was not significantly different from study start (8.8{\%} ± 0.6 vs. 8.5{\%} ± 0.6; p = 0.4). There were no significant changes in BMI{\%}, neurocognitive, parenting, and child behavior measures between groups. Conclusion: Initiation of CSII vs. continuing IIT does not significantly influence HbA1c, BMI, neurocognitive, or parenting stress parameters in a research study setting.",
keywords = "Gycemic control, Insulin pump therapy, Neurocognitive function, Parental stress, T1DM, Toddlers",
author = "Zeina Nabhan and Kreher, {Nerissa C.} and Greene, {Dennis M.} and Erica Eugster and William Kronenberger and Linda DiMeglio",
year = "2009",
doi = "10.1111/j.1399-5448.2008.00494.x",
language = "English",
volume = "10",
pages = "202--208",
journal = "Pediatric Diabetes",
issn = "1399-543X",
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T1 - A randomized prospective study of insulin pump vs. insulin injection therapy in very young children with type 1 diabetes

T2 - 12-month glycemic, BMI, and neurocognitive outcomes

AU - Nabhan, Zeina

AU - Kreher, Nerissa C.

AU - Greene, Dennis M.

AU - Eugster, Erica

AU - Kronenberger, William

AU - DiMeglio, Linda

PY - 2009

Y1 - 2009

N2 - Objective: To compare glycemic control, body mass index (BMI), neurocognitive function, and parenting stress for preschool-aged diabetic children randomized to treatment either with continuous subcutaneous insulin infusion (CSII) or with intensive insulin injection therapy (IIT). Methods: Children <5 yr of age diagnosed with type 1 diabetes mellitus for at least 12 months were randomized to either CSII (n = 21) or IIT (n = 21) for 6 months. After 6 months, the IIT group began CSII therapy and the CSII group continued on pumps. Hemoglobin A1c (HbA1c) and BMI percent were collected at baseline, 3, 6, 9, and 12 months. Neurocognitive assessments (Developmental Test of Visual-Motor Integration and Stanford-Binet Intelligence Scale: Fourth Edition) were administered to children, and parenting and child behavior assessments (Parenting Stress Index and Child Behavior Checklist) were completed by parents and at baseline, 6, and 12 months. Results: Thirty-five children completed the study. Mean HbA1c decreased significantly over the study period (8.9% ± 0.6 vs. 8.5% ± 0.7, p = 0.006). Initiation of CSII resulted in an HbA1c decrease of 0.4% after 3 months (p = 0.002); however, in the CSII first group, the HbA1c at 12 months was not significantly different from study start (8.8% ± 0.6 vs. 8.5% ± 0.6; p = 0.4). There were no significant changes in BMI%, neurocognitive, parenting, and child behavior measures between groups. Conclusion: Initiation of CSII vs. continuing IIT does not significantly influence HbA1c, BMI, neurocognitive, or parenting stress parameters in a research study setting.

AB - Objective: To compare glycemic control, body mass index (BMI), neurocognitive function, and parenting stress for preschool-aged diabetic children randomized to treatment either with continuous subcutaneous insulin infusion (CSII) or with intensive insulin injection therapy (IIT). Methods: Children <5 yr of age diagnosed with type 1 diabetes mellitus for at least 12 months were randomized to either CSII (n = 21) or IIT (n = 21) for 6 months. After 6 months, the IIT group began CSII therapy and the CSII group continued on pumps. Hemoglobin A1c (HbA1c) and BMI percent were collected at baseline, 3, 6, 9, and 12 months. Neurocognitive assessments (Developmental Test of Visual-Motor Integration and Stanford-Binet Intelligence Scale: Fourth Edition) were administered to children, and parenting and child behavior assessments (Parenting Stress Index and Child Behavior Checklist) were completed by parents and at baseline, 6, and 12 months. Results: Thirty-five children completed the study. Mean HbA1c decreased significantly over the study period (8.9% ± 0.6 vs. 8.5% ± 0.7, p = 0.006). Initiation of CSII resulted in an HbA1c decrease of 0.4% after 3 months (p = 0.002); however, in the CSII first group, the HbA1c at 12 months was not significantly different from study start (8.8% ± 0.6 vs. 8.5% ± 0.6; p = 0.4). There were no significant changes in BMI%, neurocognitive, parenting, and child behavior measures between groups. Conclusion: Initiation of CSII vs. continuing IIT does not significantly influence HbA1c, BMI, neurocognitive, or parenting stress parameters in a research study setting.

KW - Gycemic control

KW - Insulin pump therapy

KW - Neurocognitive function

KW - Parental stress

KW - T1DM

KW - Toddlers

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