Insulin pump use in young children in the T1D Exchange clinic registry is associated with lower hemoglobin A1c levels than injection therapy

Scott M. Blackman, Dan Raghinaru, Saleh Adi, Jill H. Simmons, Laurie Ebner-Lyon, H. Peter Chase, William V. Tamborlane, Desmond A. Schatz, Jennifer M. Block, Jean C. Litton, Vandana Raman, Nicole C. Foster, Craig R. Kollman, Stephanie N. Dubose, Kellee M. Miller, Roy W. Beck, Linda DiMeglio

Research output: Contribution to journalArticle

57 Citations (Scopus)

Abstract

Insulin delivery via injection and continuous subcutaneous insulin infusion (CSII) via insulin pump were compared in a cross-sectional study (n=669) and retrospective longitudinal study (n=1904) of young children (<6yr) with type 1 diabetes (T1D) participating in the T1D Exchange clinic registry. Use of CSII correlated with longer T1D duration (p<0.001), higher parental education (p<0.001), and annual household income (p<0.006) but not with race/ethnicity. Wide variation in pump use was observed among T1D Exchange centers even after adjusting for these factors, suggesting that prescriber preference is a substantial determinant of CSII use. Hemoglobin A1c (HbA1c) was lower in pump vs. injection users (7.9 vs. 8.5%, adjusted p<0.001) in the cross-sectional study. In the longitudinal study, HbA1c decreased after initiation of CSII by 0.2%, on average (p<0.001). Frequency of a severe hypoglycemia (SH) event did not differ in pump vs. injection users (p=0.2). Frequency of ≥1 parent-reported diabetic ketoacidosis (DKA) event in the prior year was greater in pump users than injection users (10 vs. 8%, p=0.04). No differences between pump and injection users were observed for clinic-reported DKA events. Children below 6yr have many unique metabolic characteristics, feeding behaviors, and care needs compared with older children and adolescents. These data support the use of insulin pumps in this youngest age group, and suggest that metabolic control may be improved without increasing the frequency of SH, but care should be taken as to the possibly increased risk of DKA.

Original languageEnglish
Pages (from-to)564-572
Number of pages9
JournalPediatric Diabetes
Volume15
Issue number8
DOIs
StatePublished - Dec 1 2014

Fingerprint

Type 1 Diabetes Mellitus
Registries
Hemoglobins
Subcutaneous Infusions
Insulin
Injections
Diabetic Ketoacidosis
Hypoglycemia
Therapeutics
Longitudinal Studies
Cross-Sectional Studies
Feeding Behavior
Retrospective Studies
Age Groups
Education

Keywords

  • Continuous subcutaneous insulin infusion
  • Insulin delivery
  • Type 1 diabetes mellitus

ASJC Scopus subject areas

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

Cite this

Insulin pump use in young children in the T1D Exchange clinic registry is associated with lower hemoglobin A1c levels than injection therapy. / Blackman, Scott M.; Raghinaru, Dan; Adi, Saleh; Simmons, Jill H.; Ebner-Lyon, Laurie; Chase, H. Peter; Tamborlane, William V.; Schatz, Desmond A.; Block, Jennifer M.; Litton, Jean C.; Raman, Vandana; Foster, Nicole C.; Kollman, Craig R.; Dubose, Stephanie N.; Miller, Kellee M.; Beck, Roy W.; DiMeglio, Linda.

In: Pediatric Diabetes, Vol. 15, No. 8, 01.12.2014, p. 564-572.

Research output: Contribution to journalArticle

Blackman, SM, Raghinaru, D, Adi, S, Simmons, JH, Ebner-Lyon, L, Chase, HP, Tamborlane, WV, Schatz, DA, Block, JM, Litton, JC, Raman, V, Foster, NC, Kollman, CR, Dubose, SN, Miller, KM, Beck, RW & DiMeglio, L 2014, 'Insulin pump use in young children in the T1D Exchange clinic registry is associated with lower hemoglobin A1c levels than injection therapy', Pediatric Diabetes, vol. 15, no. 8, pp. 564-572. https://doi.org/10.1111/pedi.12121
Blackman, Scott M. ; Raghinaru, Dan ; Adi, Saleh ; Simmons, Jill H. ; Ebner-Lyon, Laurie ; Chase, H. Peter ; Tamborlane, William V. ; Schatz, Desmond A. ; Block, Jennifer M. ; Litton, Jean C. ; Raman, Vandana ; Foster, Nicole C. ; Kollman, Craig R. ; Dubose, Stephanie N. ; Miller, Kellee M. ; Beck, Roy W. ; DiMeglio, Linda. / Insulin pump use in young children in the T1D Exchange clinic registry is associated with lower hemoglobin A1c levels than injection therapy. In: Pediatric Diabetes. 2014 ; Vol. 15, No. 8. pp. 564-572.
@article{b8bdcf28cc474bfcbf543c3d76a23d34,
title = "Insulin pump use in young children in the T1D Exchange clinic registry is associated with lower hemoglobin A1c levels than injection therapy",
abstract = "Insulin delivery via injection and continuous subcutaneous insulin infusion (CSII) via insulin pump were compared in a cross-sectional study (n=669) and retrospective longitudinal study (n=1904) of young children (<6yr) with type 1 diabetes (T1D) participating in the T1D Exchange clinic registry. Use of CSII correlated with longer T1D duration (p<0.001), higher parental education (p<0.001), and annual household income (p<0.006) but not with race/ethnicity. Wide variation in pump use was observed among T1D Exchange centers even after adjusting for these factors, suggesting that prescriber preference is a substantial determinant of CSII use. Hemoglobin A1c (HbA1c) was lower in pump vs. injection users (7.9 vs. 8.5{\%}, adjusted p<0.001) in the cross-sectional study. In the longitudinal study, HbA1c decreased after initiation of CSII by 0.2{\%}, on average (p<0.001). Frequency of a severe hypoglycemia (SH) event did not differ in pump vs. injection users (p=0.2). Frequency of ≥1 parent-reported diabetic ketoacidosis (DKA) event in the prior year was greater in pump users than injection users (10 vs. 8{\%}, p=0.04). No differences between pump and injection users were observed for clinic-reported DKA events. Children below 6yr have many unique metabolic characteristics, feeding behaviors, and care needs compared with older children and adolescents. These data support the use of insulin pumps in this youngest age group, and suggest that metabolic control may be improved without increasing the frequency of SH, but care should be taken as to the possibly increased risk of DKA.",
keywords = "Continuous subcutaneous insulin infusion, Insulin delivery, Type 1 diabetes mellitus",
author = "Blackman, {Scott M.} and Dan Raghinaru and Saleh Adi and Simmons, {Jill H.} and Laurie Ebner-Lyon and Chase, {H. Peter} and Tamborlane, {William V.} and Schatz, {Desmond A.} and Block, {Jennifer M.} and Litton, {Jean C.} and Vandana Raman and Foster, {Nicole C.} and Kollman, {Craig R.} and Dubose, {Stephanie N.} and Miller, {Kellee M.} and Beck, {Roy W.} and Linda DiMeglio",
year = "2014",
month = "12",
day = "1",
doi = "10.1111/pedi.12121",
language = "English",
volume = "15",
pages = "564--572",
journal = "Pediatric Diabetes",
issn = "1399-543X",
publisher = "Blackwell Munksgaard",
number = "8",

}

TY - JOUR

T1 - Insulin pump use in young children in the T1D Exchange clinic registry is associated with lower hemoglobin A1c levels than injection therapy

AU - Blackman, Scott M.

AU - Raghinaru, Dan

AU - Adi, Saleh

AU - Simmons, Jill H.

AU - Ebner-Lyon, Laurie

AU - Chase, H. Peter

AU - Tamborlane, William V.

AU - Schatz, Desmond A.

AU - Block, Jennifer M.

AU - Litton, Jean C.

AU - Raman, Vandana

AU - Foster, Nicole C.

AU - Kollman, Craig R.

AU - Dubose, Stephanie N.

AU - Miller, Kellee M.

AU - Beck, Roy W.

AU - DiMeglio, Linda

PY - 2014/12/1

Y1 - 2014/12/1

N2 - Insulin delivery via injection and continuous subcutaneous insulin infusion (CSII) via insulin pump were compared in a cross-sectional study (n=669) and retrospective longitudinal study (n=1904) of young children (<6yr) with type 1 diabetes (T1D) participating in the T1D Exchange clinic registry. Use of CSII correlated with longer T1D duration (p<0.001), higher parental education (p<0.001), and annual household income (p<0.006) but not with race/ethnicity. Wide variation in pump use was observed among T1D Exchange centers even after adjusting for these factors, suggesting that prescriber preference is a substantial determinant of CSII use. Hemoglobin A1c (HbA1c) was lower in pump vs. injection users (7.9 vs. 8.5%, adjusted p<0.001) in the cross-sectional study. In the longitudinal study, HbA1c decreased after initiation of CSII by 0.2%, on average (p<0.001). Frequency of a severe hypoglycemia (SH) event did not differ in pump vs. injection users (p=0.2). Frequency of ≥1 parent-reported diabetic ketoacidosis (DKA) event in the prior year was greater in pump users than injection users (10 vs. 8%, p=0.04). No differences between pump and injection users were observed for clinic-reported DKA events. Children below 6yr have many unique metabolic characteristics, feeding behaviors, and care needs compared with older children and adolescents. These data support the use of insulin pumps in this youngest age group, and suggest that metabolic control may be improved without increasing the frequency of SH, but care should be taken as to the possibly increased risk of DKA.

AB - Insulin delivery via injection and continuous subcutaneous insulin infusion (CSII) via insulin pump were compared in a cross-sectional study (n=669) and retrospective longitudinal study (n=1904) of young children (<6yr) with type 1 diabetes (T1D) participating in the T1D Exchange clinic registry. Use of CSII correlated with longer T1D duration (p<0.001), higher parental education (p<0.001), and annual household income (p<0.006) but not with race/ethnicity. Wide variation in pump use was observed among T1D Exchange centers even after adjusting for these factors, suggesting that prescriber preference is a substantial determinant of CSII use. Hemoglobin A1c (HbA1c) was lower in pump vs. injection users (7.9 vs. 8.5%, adjusted p<0.001) in the cross-sectional study. In the longitudinal study, HbA1c decreased after initiation of CSII by 0.2%, on average (p<0.001). Frequency of a severe hypoglycemia (SH) event did not differ in pump vs. injection users (p=0.2). Frequency of ≥1 parent-reported diabetic ketoacidosis (DKA) event in the prior year was greater in pump users than injection users (10 vs. 8%, p=0.04). No differences between pump and injection users were observed for clinic-reported DKA events. Children below 6yr have many unique metabolic characteristics, feeding behaviors, and care needs compared with older children and adolescents. These data support the use of insulin pumps in this youngest age group, and suggest that metabolic control may be improved without increasing the frequency of SH, but care should be taken as to the possibly increased risk of DKA.

KW - Continuous subcutaneous insulin infusion

KW - Insulin delivery

KW - Type 1 diabetes mellitus

UR - http://www.scopus.com/inward/record.url?scp=84920280939&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84920280939&partnerID=8YFLogxK

U2 - 10.1111/pedi.12121

DO - 10.1111/pedi.12121

M3 - Article

C2 - 24494980

AN - SCOPUS:84920280939

VL - 15

SP - 564

EP - 572

JO - Pediatric Diabetes

JF - Pediatric Diabetes

SN - 1399-543X

IS - 8

ER -