Insulin Pump Comparable to Injection Therapy in Pre-School Children

Glycemic control does not significantly differ between diabetic preschoolers who receive insulin pump therapy and those who receive intensive injection therapy. Dr. Linda A. DiMeglio and colleagues from Indiana University, Indianapolis, compared glycemic control, safety, and parental satisfaction for 42 diabetics preschoolers randomized to continuous subcutaneous insulin infusion or intensive insulin injection therapy.

The researchers measured hemoglobin A1c (HbA1c) at baseline, 3, and 6 months. Secondary outcomes measures included severe hypoglycemic events, meter-detected hypoglycemia, blood sugar variability, body mass index, and satisfaction with therapy.

A total of 37 patients completed 6 months of therapy, including 17 on injection therapy and 20 on pump therapy. HbA1c decreased significantly during the study for both groups (to a mean of 8.6% at 6 months).

At 3 months, children on pump therapy had a significantly lower HbA1c than those on injection therapy (8.4% versus 8.8%). However, by the 6-month visit, the groups were similar (8.5% and 8.7%, respectively).

The researchers observed no differences between groups in pre-meal blood glucose variability. The number of meter-detected episodes of hypoglycemia was higher in the group using pumps than in those on injection therapy. There were no episodes of ketoacidosis observed in either treatment group. One hypoglycemic seizure occurred in each group.

Parents were satisfied with pump therapy, and 95% of families continued on the treatment beyond the 6 months.

"It remains to be seen whether the benefit of insulin pump therapy in terms of flexibility and convenience justifies the increased costs for very young children with diabetes," the researchers conclude. "Studies of long-term outcomes of children begun on pump therapy at very young ages also are needed." J Pediatr 2004;145:380-384.