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 A. Dimeglio

Research output: Contribution to journalArticle

67 Scopus citations

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

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)

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    Blackman, S. M., Raghinaru, D., Adi, S., Simmons, J. H., Ebner-Lyon, L., Chase, H. P., Tamborlane, W. V., Schatz, D. A., Block, J. M., Litton, J. C., Raman, V., Foster, N. C., Kollman, C. R., Dubose, S. N., Miller, K. M., Beck, R. W., & Dimeglio, L. A. (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, 15(8), 564-572. https://doi.org/10.1111/pedi.12121