Safety and Effectiveness of Insulin Pump Therapy in Children and Adolescents With Type 1 Diabetes
- Leslie P. Plotnick, MD1,
- Loretta M. Clark, RN, BSN, CDE1,
- Frederick L. Brancati, MD, MHS234 and
- Thomas Erlinger, MD, MPH234
- 1Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland
- 2Department of Medicine, Johns Hopkins University, Baltimore, Maryland
- 3Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- 4Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, Maryland
Abstract
OBJECTIVE—To evaluate the safety and effectiveness of insulin pump therapy in children and adolescents with type 1 diabetes.
RESEARCH DESIGN AND METHODS—All 95 patients who began insulin pump therapy at Johns Hopkins Hospital between January 1990 and December 2000 were included in the study. The mean age was 12.0 years (range 4–18), and 29% of the patients were <10 years old. Data were obtained by chart review beginning 6–12 months before pump start. The median duration of follow-up was 28 months.
RESULTS—There was a small but significant decrease in HbA1c at 3–6 months after pump start (7.7 vs. 7.5%; P = 0.03). HbA1c levels then gradually increased and remained elevated after 1 year of follow-up; however, this association was confounded by age and diabetes duration, both of which were associated with higher HbA1c levels. After adjusting for duration and age, mean HbA1c after pump start was significantly lower than before pump start (7.7 vs. 8.1%; P < 0.001). The number of medical complications (diabetic ketoacidosis, emergency department visits) was similar before and after pump start. There were fewer hypoglycemic events after pump start (12 vs. 17, rate ratio 0.46, 95% CI 0.21–1.01).
CONCLUSIONS—This study suggests that pump therapy is safe and effective in selected children and adolescents with type 1 diabetes.
Footnotes
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Address correspondence and reprint requests to Leslie P. Plotnick, MD, Johns Hopkins Hospital, Park 211, 600 N. Wolfe St., Baltimore, MD 21287. E-mail: lplotni{at}jhmi.edu.
Received for publication 22 October 2002 and accepted in revised form 3 January 2003.
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