Systems of continuous subcutaneous insulin infusion to maintain metabolic compensation for type 1 diabetes mellitus among children and adolescents

BACKGROUND: Insulin pumps (IP) are a widespread treatment for type 1 diabetes mellitus (T1D) in children because of its several advantages over multiple insulin injection regimens (MII). However, the long-term effectiveness of continuous subcutaneous insulin infusion (CSII) in achieving and maintain...

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Autores principales:	Elena B. Bashnina, Irina M. Tsargasova, Olga A. Klitsenko
Formato:	article
Lenguaje:	EN RU
Publicado:	Endocrinology Research Centre 2019
Materias:	children adolescents type 1 diabetes mellitus insulin pump glycemia Nutritional diseases. Deficiency diseases RC620-627
Acceso en línea:	https://doaj.org/article/50472a06361240b490376df808335ec1
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spelling	oai:doaj.org-article:50472a06361240b490376df808335ec12021-11-14T09:00:22ZSystems of continuous subcutaneous insulin infusion to maintain metabolic compensation for type 1 diabetes mellitus among children and adolescents2072-03512072-037810.14341/DM10208https://doaj.org/article/50472a06361240b490376df808335ec12019-12-01T00:00:00Zhttps://www.dia-endojournals.ru/jour/article/view/10208https://doaj.org/toc/2072-0351https://doaj.org/toc/2072-0378BACKGROUND: Insulin pumps (IP) are a widespread treatment for type 1 diabetes mellitus (T1D) in children because of its several advantages over multiple insulin injection regimens (MII). However, the long-term effectiveness of continuous subcutaneous insulin infusion (CSII) in achieving and maintaining sustained metabolic compensation remains controversial. OBJECTIVE: To determine the factors affecting the long-team effectiveness of CSII in children and adolescents with T1DM in real clinical practice. METHODS: Data of 239 children and adolescents treated with CSII for ≥3 years were examined during the registration of patients receiving insulin pump therapy in Saint-Petersburg was formed. HbA1с level changes over time were analysed before switching to CSII and were assessed depending on sex and age, baseline HbA1с level and factors as the frequency of using continuous glucose monitoring (CGM), temporary transitions from CSII to MII with injection pens and use of bolus calculators (BC). RESULTS: The final HbA1с value showed no significant changes as compared with the HbA1с level before switching to CSII (baseline, 7.82±1.46%; final, 7.93±1.30%). Approximately 42% of patients had HbA1с level of <7.5%. Better results were observed in the 4.5–7-year age group, where 67% of patients had HbA1с level of <7.5%; in 12–18-year age group, only 35% of patients reached the target HbA1с level. Majority of patients with baseline HbA1с level of <7.5% remained within the target level during the final examination, whereas only 23% of patients with HbA1с level of ≥7.5% before switching to CSII reached the target level. Better glycaemic control was also observed in patients treated with CSII regularly, as compared to patients who periodically switched to MII with the injection pen (p<0.05). HbA1с appeared to be lower in the group of 12–18-year-old adolescents who used CGM regularly, as compared to the group not treated with CGM (p<0.05). CONCLUSION: Children and adolescents treated with CSII for ≥3 years did not experience a significant improvement in metabolic control. However, the influence of factors in maintaining the metabolic control, such factors as the patient’s age, initial HbA1с level, CGM use and frequency, and the presence or absence of changes in insulin therapy regimen is observed.Elena B. BashninaIrina M. TsargasovaOlga A. KlitsenkoEndocrinology Research Centrearticlechildrenadolescentstype 1 diabetes mellitusinsulin pumpglycemiaNutritional diseases. Deficiency diseasesRC620-627ENRUСахарный диабет, Vol 22, Iss 6, Pp 550-558 (2019)
institution	DOAJ
collection	DOAJ
language	EN RU
topic	children adolescents type 1 diabetes mellitus insulin pump glycemia Nutritional diseases. Deficiency diseases RC620-627
spellingShingle	children adolescents type 1 diabetes mellitus insulin pump glycemia Nutritional diseases. Deficiency diseases RC620-627 Elena B. Bashnina Irina M. Tsargasova Olga A. Klitsenko Systems of continuous subcutaneous insulin infusion to maintain metabolic compensation for type 1 diabetes mellitus among children and adolescents
description	BACKGROUND: Insulin pumps (IP) are a widespread treatment for type 1 diabetes mellitus (T1D) in children because of its several advantages over multiple insulin injection regimens (MII). However, the long-term effectiveness of continuous subcutaneous insulin infusion (CSII) in achieving and maintaining sustained metabolic compensation remains controversial. OBJECTIVE: To determine the factors affecting the long-team effectiveness of CSII in children and adolescents with T1DM in real clinical practice. METHODS: Data of 239 children and adolescents treated with CSII for ≥3 years were examined during the registration of patients receiving insulin pump therapy in Saint-Petersburg was formed. HbA1с level changes over time were analysed before switching to CSII and were assessed depending on sex and age, baseline HbA1с level and factors as the frequency of using continuous glucose monitoring (CGM), temporary transitions from CSII to MII with injection pens and use of bolus calculators (BC). RESULTS: The final HbA1с value showed no significant changes as compared with the HbA1с level before switching to CSII (baseline, 7.82±1.46%; final, 7.93±1.30%). Approximately 42% of patients had HbA1с level of <7.5%. Better results were observed in the 4.5–7-year age group, where 67% of patients had HbA1с level of <7.5%; in 12–18-year age group, only 35% of patients reached the target HbA1с level. Majority of patients with baseline HbA1с level of <7.5% remained within the target level during the final examination, whereas only 23% of patients with HbA1с level of ≥7.5% before switching to CSII reached the target level. Better glycaemic control was also observed in patients treated with CSII regularly, as compared to patients who periodically switched to MII with the injection pen (p<0.05). HbA1с appeared to be lower in the group of 12–18-year-old adolescents who used CGM regularly, as compared to the group not treated with CGM (p<0.05). CONCLUSION: Children and adolescents treated with CSII for ≥3 years did not experience a significant improvement in metabolic control. However, the influence of factors in maintaining the metabolic control, such factors as the patient’s age, initial HbA1с level, CGM use and frequency, and the presence or absence of changes in insulin therapy regimen is observed.
format	article
author	Elena B. Bashnina Irina M. Tsargasova Olga A. Klitsenko
author_facet	Elena B. Bashnina Irina M. Tsargasova Olga A. Klitsenko
author_sort	Elena B. Bashnina
title	Systems of continuous subcutaneous insulin infusion to maintain metabolic compensation for type 1 diabetes mellitus among children and adolescents
title_short	Systems of continuous subcutaneous insulin infusion to maintain metabolic compensation for type 1 diabetes mellitus among children and adolescents
title_full	Systems of continuous subcutaneous insulin infusion to maintain metabolic compensation for type 1 diabetes mellitus among children and adolescents
title_fullStr	Systems of continuous subcutaneous insulin infusion to maintain metabolic compensation for type 1 diabetes mellitus among children and adolescents
title_full_unstemmed	Systems of continuous subcutaneous insulin infusion to maintain metabolic compensation for type 1 diabetes mellitus among children and adolescents
title_sort	systems of continuous subcutaneous insulin infusion to maintain metabolic compensation for type 1 diabetes mellitus among children and adolescents
publisher	Endocrinology Research Centre
publishDate	2019
url	https://doaj.org/article/50472a06361240b490376df808335ec1
work_keys_str_mv	AT elenabbashnina systemsofcontinuoussubcutaneousinsulininfusiontomaintainmetaboliccompensationfortype1diabetesmellitusamongchildrenandadolescents AT irinamtsargasova systemsofcontinuoussubcutaneousinsulininfusiontomaintainmetaboliccompensationfortype1diabetesmellitusamongchildrenandadolescents AT olgaaklitsenko systemsofcontinuoussubcutaneousinsulininfusiontomaintainmetaboliccompensationfortype1diabetesmellitusamongchildrenandadolescents
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Systems of continuous subcutaneous insulin infusion to maintain metabolic compensation for type 1 diabetes mellitus among children and adolescents

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