Metabolic control with insulin pump therapy: the Waikato experience.

7.9 ±1.0% (P<0.001) at 3 months and 7.9 ±0.95% (P<0.001) at 6 months post CSII. This reduction was maintained after 1, 2, and 3 years and the difference was statistically significant (P<0.001). In the adolescent subgroup (n=27) we observed a similar significant reduction in HbA 1c % that was maintained after 1 year of pump therapy. The incidence of severe hypoglycaemia was reduced from 0.75 cases per patient-year during multiple daily injection (MDI) pre-pump to 0.05 cases per patientyear during CSII (P<0.001). In some cases hypoglycaemia awareness was restored. There was no evidence to suggest increased tendency for diabetic ketoacidosis (DKA) with continuing use of insulin pumps. Conclusion Our experience showed that insulin pump therapy was effective and safe for both adults and adolescents with Type 1 diabetes. The reduction in HbA 1c % was both statistically and clinically highly significant. Wider usage of this technology in New Zealand is warranted. The Diabetes Control and Complications Trial (DCCT) demonstrated that, in patients with Type 1 diabetes, tight metabolic control achieved with intensive insulin therapy is superior to conventional treatment in reducing the risk of long-term microvascular complications. 1 Evidence is also accumulating that the prepubertal and pubertal years have an impact on microvascular complications in diabetes. 2,3 Therefore, tight metabolic control may be particularly important during these years. Both continuous subcutaneous insulin infusion (CSII) with external insulin pumps and multiple daily injection (MDI) therapy are effective means of implementing intensive diabetes management with the goal of achieving near-normal levels of blood glucose and improved lifestyle flexibility. CSII is a viable alternative to MDI therapy for patients with Type 1 diabetes who are capable, motivated, and trained to use insulin pumps. 4-7 Insulin pump therapy has evolved considerably since the first portable infusion pumps were used for continuous insulin delivery by John Pickup and his colleagues at Guy’s Hospital in London 8 and subsequently by William Tamborlane and his colleagues at