Comparable glycemic management with insulin pumps vs MDI in kids with kind 1 diabetes


medwireNews: The use of an insulin pump is not associated with better blood sugar control than multiple daily injections (MDI) in children and adolescents with type 1 diabetes.

The researchers used the SWEDIABKIDS registry to analyze data from all people aged 0-17 with type 1 diabetes in Sweden between 2011 and 2016, which corresponds to 35,624 person-years.

Anna-Lena Fureman (University of Umeå, Sweden) and co-authors report a “general decrease” in glycated hemoglobin level (HbA1c) during the study period, regardless of the method of insulin delivery, without increasing the rate of severe hypoglycaemia currently.

In the various age and gender groups, the decrease in the average HbA1c level from 2011 to 2016 was around 0.5% (2–5 mmol / mol), while the proportion of people who used insulin pumps was 41% in girls. increased to 60% 35% to 56% in boys.

Fureman et al. Say that the mean HbA1c levels in children and teenagers who used insulin pumps were about 0.1% lower compared to MDI in 2011. When individuals were categorized by age, gender, and baseline HbA1c, there were no significant differences in mean HbA1c levels on insulin pumps compared to using MDI with the exception of two subgroups.

Among those with HbA1c levels above 8.7% (72 mmol / mol) at baseline, the use of insulin pumps was associated with a lower HbA1c value than MDI, with average levels of 9.2% versus 9.4% (77, 4 vs. 79.1 mmol / mol) in 2011 and 9.3% vs. 9.5% (78.5 vs. 80.5 mmol / mol) in 2016.

Insulin pump users had higher mean HbA1c levels than MDI users in boys aged 13 to 17, at 8.2% versus 7.9% (66.3 versus 63.3 mmol / mol) in 2011 and 7.7 % versus 7.5% (60.3 versus 58.2 mmol / mol) in 2011 2016.

Although these differences were statistically significant at most time points, the researchers say the decreases in HbA1c associated with insulin pump use were “tiny” and had “little clinical relevance”.

However, you write in Pediatric Diabetes that the use of insulin pumps “can still be worthwhile, based on treatment benefits that we have not investigated, such as: B. Improved treatment satisfaction, improved quality of life, ease of carbohydrate counting and the coming combination with [continuous glucose monitoring] To create closed loop systems. “

The team also assessed body composition and found that teenagers, especially girls, tended to have a higher BMI standard deviation (SDS) when they used an insulin pump. The mean BMI-SDS for girls aged 13 to 17 years was significantly higher, at 0.97 versus 0.78 in 2011 and 0.98 versus 0.80 in 2016.

“One explanation could be that girls with high BMI-SDS may have insulin resistance, which can lead to higher HbA1c, which prompts doctors to care for them [insulin pump] Treatment to improve their metabolic control, ”the researchers speculate.

They add, “If so, those involved in the health care of children with type 1 diabetes should look for ways to prevent preventable increases in BMI by supporting patients and families, such as recommendations for healthy eating and physical activity encouragement. ”

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Pediatr Diabetes 2021; doi: 10.1111 / pedi.13217