Few Diabetic Children With Infusion Pumps Achieve Optimal A1C

According to the results of a new study, only a minority of children with type 1 diabetes reach their target level of glycated hemoglobin, even when using the best insulin delivery system currently available.

Continuous subcutaneous insulin infusion (CSII) is more convenient for patients, requiring fewer injections while enhancing glucose control and improving lifestyle flexibility, Dr. Jennifer J. F. McVean and associates note.

To determine why so few children are successful, they reviewed medical records of 236 patients, aged 2 to 22 years, being treated at their pediatric diabetes clinic. Included were patients with diabetes for at least a year and using CSII for at least 6 months.

Results showed that 90 (38%) of patients had met their A1C goal at their most recent clinic visit, including 63% of those aged 6 to 12 years, 33% of those aged 13 to 19 years, and 22% of older patients (p < 0.001).
Successful treatment was associated with younger age, shorter duration of diabetes, lower A1C before starting CSII, and more catheter sites.

On the other hand, blood glucose control was not associated with gender, frequency of clinic visits, days between catheter changes, or duration of CSII use.

Dr. McVean and her colleagues from the University of Wisconsin School of Medicine in Madison,  suggest that better blood glucose control would be achieved by starting children on CSII at a younger age, closer follow-up, continued diabetes education in older patients, and using more catheter sites.

Diabetes Care 2007;30:2499-2500.