Diabetes in Toddlers | Pumps and Paediatrics | CSII vs MDI in Adolescents | Severe Hypos | DKA Rates in Children | Day-to-day Fluctuations of Insulin Absorption | HbA1c & Frequency of Blood Glucose | Effect of Insulin Glargine


Diabetes in toddlers & preschool children with type 1 DM

Litton et al 2002 (n=9 aged 10-40 months)

Factors leading to poor control

  • Unpredictable food intake
  • Unpredictable activity levels
  • Imprecise administration of low doses of insulin
  • Frequent viral infections
  • Inability to communicate symptoms of low BG, predisposing to frequent hypos

Diabetes in toddlers & preschool children with type 1 DM

Litton et al 2002 (2)
  • Patient selection criteria
  • Recurrent moderate/severe hyperglycaemia
  Pre-pump Post-pump
HbA1c persistently > 9.0 9.5 +/- 0.4 7.9 +/- 0.3
Insulin dose no sig diffs
BG recordings no sig diffs
Linear growth no sig diffs
Weight gain no sig diffs
Severe hypos/ mth 0.52 +/- 0.1 0.09 +/_ 0.02
Parental clinic contact-days 5.9 +/- 1.5 46.3 +/- 4.4

Diabetes in toddlers & preschool children with type 1 DM

Litton et al 2002 (4)
  • A controlled study of the effects of discontinuation of pump therapy could not be conducted because all our families preferred CSII to MDI and refused to consider a return to previous modes of insulin administration
  • ...the frequency of parental contacts with health personnel declined by >80 continued with CSII

Pumps & Paediatrics

Aherne et al 2002 (n=169: age range=1.5-18 yrs)
  • “CSII [insulin pump therapy] is an effective alternative to injection therapy in a large paediatric diabetes clinic setting. Even very young patients can utilise CSII to safely lower HbA1c levels”.
  • “Improved diabetes control was achieved with CSII without increasing daily insulin doses and in association with a decrease in the frequency of severe hypoglycaemic events (p=0.05 vs prepump, all three ages combined)”.
  • “There was a significant and consistent reduction in mean HbA1c levels after 12 months of CSII…(p=<0.02 vs prepump) that was maintained at the most recent visit”.
  • “The remarkable effectiveness of CSII in our youngest patients indicates that the child’s age should not be a barrier to the initiation of this therapy”

CSII vs MDI in adolescents: n=75

Boland et al 2000 CSII vs MDI in adolescents CSII vs MDI in adolescents CSII vs MDI in adolescents

Severe hypos - events/100 pt yrs (n=55)

Bode et al 1996
  • Severe hypos 138 (MDI) vs 22 (Yr 1 CSII).. 36 (Yr 4 CSII)
  • Total insulin dose reduced from 42.9 (MDI) to 36.4 (Yr1)..37.8 (Yr4)
  • DKA rates were 14.6 / MDI vs 7.6 CSII per 100 pt years ie - No significant difference

DKA Rates in Children & Adolescents (n=6)

Steindel et al 1995
  • MDI vs CSII
  • DKA episodes 31 vs 10
  • Mean no. hospitalisation/pt 5.2 vs1.7
  • Mean no. hospital days/pt 20.8 vs 5
  • Mean Treatment costs/pt - $'000 $29.33 vs $12.76

Less Day-to-day Fluctuations of Insulin Absorption During CSII Compared to Single Injections of Intermediate-acting Insulin

The absorption of 125I-labeled insulin by six diabetics during injection therapy, respectively eight patients with continuous subcutaneous insulin infusion, was determined during several days.*


Correlation Between HbA1c and Frequency of Blood Glucose Self-monitoring Under Insulin Pump Treatment

Results of a questionnaire* on diabetics with an insulin pump treatment in Germany in 1998/1999. 2481 data sets

{(Diabetes duration: 20 ± 11 years; Treatment with an insulin pump: 3 ± 5 years; Frequency of daily blood glucose self-monitoring: 5.4 ± 1.8; HbA1c: 6.9 ± 1.1 %)


Effect of insulin Glargine compared with NPH on the frequency of hypoglycemia in patients with type 1 diabetes

Glargine Compared with NPH.jpg