Durability of Insulin Pump Use in Pediatric Patients With Type 1 Diabetes
- Jamie R. Wood, MD,
- Elaine C. Moreland, MD,
- Lisa K. Volkening, BA,
- Britta M. Svoren, MD,
- Deborah A. Butler, MSW and
- Lori M.B. Laffel, MD, MPH
- 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
Abstract
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 HbA1c (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.
Footnotes
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E.C.M. is currently affiliated with the Pediatric Division of Endocrinology, University of Alabama Birmingham, Children’s Hospital, Birmingham, Alabama.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.
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- Accepted August 2, 2006.
- Received June 2, 2006.
- DIABETES CARE
