Durability of Insulin Pump Use in Pediatric Patients With Type 1 Diabetes

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 HbA 1c (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 P 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.