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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

¹ Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
² Department of Pediatric Endocrinology, Diabetes and Metabolism, University Children's Hospital, Ljubljana, Slovenia
³ Section of Pediatric Endocrinology, Indiana University School of Medicine, James Whitcomb Riley Hospital for Children, Indianapolis, Indiana
⁴ Diabeteszentrum fur Kinder und Jugendliche, Kinderkrankenhaus auf der Bult, Hannover, Germany
⁵ Center for Diabetes, Endocrinology and Metabolism, Childrens Hospital, Los Angeles, California

Address correspondence and reprint requests to Prof. Moshe Phillip, Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, 14 Kaplan St., Petah Tikva 49202, Israel. E-mail: mosheph@post.tau.ac.il

Abbreviations: ADA, American Diabetes Association • CSII, continuous subcutaneous insulin infusion • DCCT, Diabetes Control and Complications Trial • DKA, diabetic ketoacidosis • EASD, European Association for the Study of Diabetes • ESPE, European Society for Paediatric Endocrinology • ISPAD, International Society for Pediatric and Adolescent Diabetes • LWPES, Lawson Wilkins Pediatric Endocrine Society • MDI, multiple daily injection • QALY, quality-adjusted life year • QOL, quality of life • RCT, randomized controlled trial

The first 300 words of the full text of this article appear below.

	INTRODUCTION

 
Young patients with diabetes, their families, and their diabetes care providers continue to be faced with the challenge of striving to maintain blood glucose levels in the near-normal range. High blood glucose levels with elevated A1C levels are associated with long-term microvascular and macrovascular complications. Recurrent episodes of hypoglycemia, especially at young ages, may cause short- and long-term adverse effects on cognitive function and lead to hypoglycemia unawareness and may be associated with significant emotional morbidity for the child and parents. Fear of hypoglycemia, especially during the night, may compromise quality of life (QOL) for the family and jeopardize efforts to achieve optimal metabolic control.

Over the past decade, continuous subcutaneous insulin infusion (CSII) has gained increasing popularity among patients with diabetes. CSII is the most physiologic method of insulin delivery currently available. It is able to closely simulate the normal pattern of insulin secretion, namely continuous 24-h adjustable "basal" delivery of insulin upon which are superimposed prandial "boluses." In addition, CSII offers the possibility of more flexibility and more precise insulin delivery than multiple daily injection (MDI). However, there is still debate among diabetes care practitioners around the world as to whether CSII has advantages over MDI in terms of reduction in A1C levels, occurrence of severe hypoglycemic events, episodes of diabetic ketoacidosis (DKA), and frequency of hospitalizations in young patients. Furthermore, no clear criteria have been established to help the physician choose the "appropriate" patient for CSII therapy.

To address these issues, the European Society for Pediatric Endocrinology (ESPE), the Lawson Wilkins Pediatric Endocrine Society (LWPES), and the International Society for Pediatric and Adolescent Diabetes (ISPAD) convened a panel of expert physicians for a consensus conference endorsed by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD).

For each major topic area, . . . [Full Text of this Article]

	BENEFITS AND RISKS OF CSII IN PEDIATRIC AND ADOLESCENT PATIENTS—WHAT WE KNOW SO FAR

 
Impact on A1C
Recommendation.
Severe hypoglycemia
Recommendation.
Blood glucose variability
Recommendations.
Physical activity and exercise
Conclusions.
Weight gain
Conclusions.
Metabolic deterioration
Recommendations.
Infusion site reactions
Conclusion.
Psychosocial issues
Conclusion.

	CSII USE IN THE PEDIATRIC PATIENT

 
Initiating CSII
Recommendations
CSII supportive care
Recommendations

	PERSONALIZING CSII

 
Selecting an insulin pump
Pump features requiring consideration include:
Determining which concentration and type of insulin to use
Recommendations
Selecting a catheter
Catheter features requiring consideration include:
Recommendations
Calculating the total daily insulin requirements when switching from MDI to CSII
Recommendations
Calculating the basal insulin rate
Recommendations
Calculating and timing the prandial (bolus) insulin requirement
Recommendations
Calculating the correction dose
Recommendations
Monitoring patients on CSII
Recommendations.
Terminating CSII
Recommendations.
Cost-effectiveness
Conclusions.

	CONCLUSIONS—

 
Participants in the consensus forum

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