ESPEYB15 10 Type 1 Diabetes Mellitus Continuous glucose monitoring, insulin pumps and artificial pancreas (7 abstracts)
10.8 Association of insulin pump therapy vs insulin injection therapy with severe hypoglycemia, ketoacidosis, and glycemic control among children, adolescents, and young adults with T1DM
Karges B , Schwandt A , Heidtmann B , Kordonouri O , Binder E , Schierloh U , Boettcher C , Kapellen T , Rosenbauer J & Holl RW
Division of Endocrinology and Diabetes, Medical Faculty, RWTH Aachen University, Aachen, Germany
To read the full abstract: JAMA. 2017;318:1358-1366
Here, the authors compared the metabolic control in young patients with T1DM with insulin pump therapies versus multiple injection treatment modalities using the data from 30 579 patients younger than 20 years of age of 446 centers in a prospective population-based cohort study. While it is very clear that pump therapy, compared with injection therapy, was associated with lower rates of severe hypoglycemia and diabetic ketoacidosis and HbA1c levels were lower with pump therapy than with injection therapy it remains unclear why this is so: there could be a treatment allocation bias, in such it could be that patients with better adherence to therapy are put on insulin pumps more readily than patients whose HbA1c at the very beginning is higher and who show low treatment adherence and high rates of psychosocial risks. In addition, more educated and more involved families may push more for pumps. Also, patients on pump therapy may benefit more from better diabetes education regimens than patients on more conventional therapies. Needless to say, pump therapy is safe, has proven to be practical and feasible in the day-to-day setting and offers benefits that should be offered to any child with diabetes worldwide. In view of the fact that until to this very day, insulin is still not offered to many children with diabetes in poor countries, one has to acknowledge that there is yet a long way before this will be achieved.
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ESPE Yearbook of Paediatric Endocrinology
ISSN 1662-4009 (Online)
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