Continuous subcutaneous insulin infusion in children and adolescents with diabetes mellitus: decreased HbA1c with low risk of hypoglycemia.

Aim: To evaluate blood glucose and HbA 1 c levels, insulin dosage, hypoglycemia rate and body mass index (BMI) at baseline, and at 3 and 6 months after initiation of continuous subcutaneous insulin infusion (CSII) in children and youth with type 1 diabetes mellitus (DM). Methods: A 6-month trial of pump therapy was carried out in 40 patients with type 1 DM and one with cystic fibrosis (CF) induced DM (25 males), aged 4-25 years (mean 13.5 ′4.2 [SD); 4-8 years, n = 6; 8-10 years, n = 8; 10-12 years, n = 4; 12-15 years, n = 11; >15 years, n = 12). Results: HbA 1 c was significantly reduced from 9.5 ′1.7% to 8.6 ′1.2% at 3 months (p <0.03), and at 6 months 8.8 ′1.5% (p <0.05). The mean daily values of blood glucose, as well as individual mean values of blood glucose at fasting and before lunch, also exhibited a significant reduction (p <0.05)at 3 and 6 months. There was a significant reduction in the number of hypoglycemic events (level of plasma glucose <3.3 mmol/l,calculated as number of events per patient/30 days) at 3 months (6.5 ′5.5 vs 2.8 ′ 3.3; p = 0.02) and at 6 months (6.5 ′5.5 vs 3.5 ′ 3.0; p = 0.04). The insulin requirement dropped by 27.2% (1.03 ′0.30 U/kg/day before starting CSII; 0.75 ′020 U/kg/day on insulin pump therapy onset; 0.76 ′0.18 U/kg/day at 3 months; 0.75 ′0.21 U/kg/day at 6 months). During the follow-up 0.10 events of diabetic ketoacidosis/ patient/year were recorded. The patients exhibited no increase in BMI during the 6 months of follow-up. Conclusion: CSIIwas safe and effective in improving short- and medium-term metabolic control in young adults, adolescents and younger children with DM.