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Durability of Insulin Pump Use in Pediatric Patients With Type 1 Diabetes

From the Pediatric, Adolescent, and Young Adult Section, Genetics and Epidemiology Section, Joslin Diabetes Center, Boston, Massachusetts

Address correspondence and reprint requests to Lori M.B. Laffel, MD, MPH, Pediatric, Adolescent, and Young Adult Section, Genetics and Epidemiology Section, Joslin Diabetes Center, One Joslin Place, Boston, MA 02215. E-mail: lori.laffel{at}joslin.harvard.edu

OBJECTIVE—To examine longitudinal outcomes, rate of and reasons for discontinuation, and predictors of insulin pump success in a cohort of youth initiating pump therapy.

RESEARCH DESIGN AND METHODS—We followed a cohort of youth with type 1 diabetes (n = 161) starting the pump between 1998 and 2001 and recorded natural history of treatment.

RESULTS—At pump start, patients (71% female) had a mean age of 14.1 ± 3.7 years, diabetes duration of 7.1 ± 4.0 years, daily blood glucose monitoring (BGM) frequency of 4.0 ± 1.2, a daily insulin dose of 1.0 ± 0.3 units/kg, and an HbA_1c (A1C) of 8.4 ± 1.4%. After 1 year, mean daily BGM frequency was 4.5 ± 1.7, daily insulin dose was 0.8 ± 0.2 units/kg, and A1C was 8.1 ± 1.3% (all baseline versus 1-year data, P < 0.01). As of 2005, 29 patients (18%) had resumed injection therapy at a mean age of 17.0 ± 2.9 years after a mean duration of pump use of 2.1 ± 1.3 years. BGM frequency at baseline and at 1 year was significantly lower in the patients who resumed injection therapy (P < 0.02). In addition, patients who remained on the pump had lower A1C than those who resumed injection therapy at both 1 year (P = 0.04) and at the most recent clinic visit (P = 0.01).

CONCLUSIONS—After an average of 3.8 years, >80% of pediatric patients maintained pump therapy with preservation of baseline A1C. Patients discontinuing the pump were less adherent and did not achieve equivalent glycemic benefit compared with continued users; these patients require ongoing support aimed at improving adherence and outcomes.

Abbreviations: BGM, blood glucose monitoring • CSII, continuous subcutaneous insulin infusion

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				M. Phillip, T. Battelino, H. Rodriguez, T. Danne, F. Kaufman, and for the Consensus forum participants Use of Insulin Pump Therapy in the Pediatric Age-Group: Consensus statement from the European Society for Paediatric Endocrinology, the Lawson Wilkins Pediatric Endocrine Society, and the International Society for Pediatric and Adolescent Diabetes, endorsed by the American Diabetes Association and the European Association for the Study of Diabetes Diabetes Care, June 1, 2007; 30(6): 1653 - 1662. [Full Text] [PDF]