Insulin pumps better than injections for diabetic children

Insulin pumps better than injections for diabetic children

The study published online today in Diabetologia, the journal of the European Association for the Study of Diabetes, found insulin pumps were a better option when treating children.

Over the past 15 years, insulin pump therapy has been increasingly used, especially in children, due to improvements in pump technology, availability of insulin analogues, and the results of the Diabetes Control and Complications Trial, which established the benefits offered by improved blood sugar control.

Despite this increased use, the outcomes of pump therapy are still debated and there has been inadequate research into the long-term effects of pump therapy in children. Researchers led by Associate Professor Elizabeth Davis of the Princess Margaret Hospital for Children, Perth, Australia studied 345 patients on pump therapy. These patients were matched to control patients on injections, with an average age of 11 years (ranging between 2 and 19 years), with an average duration of diabetes at the start of pump therapy of 4.1 years and an average follow up of 3.5 years.

The average HbA1c reduction in the pump cohort was 0.6% (6.6 mmol/mol). This improved HbA1c remained significant until seven years of follow up. Both groups started with the same HbA1c and maximum difference was 1% difference at 6 yrs – 7.6% in the pump group and 8.6% in the non-pump group. The researchers found that pump therapy reduced episodes of severe hypoglycaemia from 14.7 to 7.2 events per 100 patients per year. In contrast, severe hypoglycaemia increased in the non-pump cohort over the same period from 6.8 to 10.2 events per 100 patients per year.

The rate of admission for diabetic ketoacidosis – the shortage of insulin causing the body to switch to burning fats and producing acidic ketone molecules that cause complications and symptoms – was lower in patients receiving pump therapy than in the non-pump group (2.3 vs 4.7 per 100 patients per year) during follow up.

Dr Davis said: “Our data confirm that insulin pump therapy provides an improvement in glycaemic control which is sustained for at least seven years.

“Children and adolescents with poor control had the greatest reduction in HbA1c with insulin pump therapy. Although this is not a randomised trial, it is ‘real life’ experience in a large population based sample over a prolonged time period and as such provides important information.”

Bridget Turner, director of policy and care improvement for Diabetes UK, said: “This provides further evidence that using insulin pumps can help children with type 1 diabetes achieve good blood glucose control and, with the right education and specialist nursing support, in the long term this can help reduce risk of serious complications such as amputation, blindness and kidney failure.

“This is why it is a real concern that the UK is lagging behind comparable countries in terms of insulin pump usage. We want the NHS to do more to ensure there are enough healthcare professionals who are qualified to support children and adults with type 1 diabetes to use a pump effectively, so that everyone who wants to use one is able to do so.”




By Adrian O'Dowd

On Medica, 19th August 2013




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