Predictors of glycemic control on insulin pump therapy in children and adolescents with type I diabetes

Objective: To determine variables predictive of glycemic control in a large population of pediatric patients with type 1 diabetes on continuous subcutaneous insulin infusion (CSII). Methods: Charts of patients on CSII for ≥1 year were reviewed. "Good" control was a priori defined as HbA1c ≤9% in patients under 12 years of age, and ≤8% in patients over 12 years. Results: Ninety-three patients were identified (57 girls and 36 boys). Their mean age at pump start was 11.6 ± 3.1 years with duration of diabetes of 4.7 ± 3.1 years. Average time on pump therapy was 2.4 ± 0.8 years. HbA1C decreased from 8.7 ± 0.9% prior to pump therapy to 8.3 ± 0.6% while on CSII (p < 0.01). Despite analysis of a large number of possible predictors, only number of basal rates (4.4 versus 3.4) and younger age (10.0 years versus 13.1 years) correlated with good control. Conclusion: Only younger age and use of more basal rates were predictive of good diabetes control in children using CSII. Decisions regarding which pediatric patients are most appropriate for CSII must continue to be individualized.