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Insulin pump more effective than injections in children with diabetes
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Long-term insulin pump therapy improved glycemic control and decreased hypoglycemia and hospitalization for diabetic ketoacidosis in children with diabetes compared with insulin injections, according to researchers.
“This is the largest study of insulin pump use in children. It also has the longest follow-up period of any study of insulin pump therapy in children. Our data confirm that insulin pump therapy improves glycemic control, with improvements being sustained for at least 7 years,” Stephanie R. Johnson, PhD, from the department of endocrinology and diabetes at Princess Margaret Hospital for Children in Australia, and colleagues wrote.
The researchers used data from the Western Australian Childhood Diabetes Database and matched 345 children on pump therapy to controls on injections (aged 2 to 19 years). Mean duration of diabetes at initiation of pump therapy was 4.1 years, and mean follow-up was 3.5 years.
According to Johnson and colleagues, HbA1c was 8% in both groups at the start of the study. In the pump cohort, mean reduction in HbA1c was 0.6% — an improvement that remained significant through 7 years. Maximum difference in HbA1c between the two groups reached 1% at 6 years.
Pump therapy also decreased the incidence of severe hypoglycemia from 14.7 events to 7.2 events per 100 patient-years (P<.001), according to data. However, severe hypoglycemia increased in the non-pump cohort during the same period (6.8 to 10.2 events per 100 patient-years), researchers wrote.
During the 1,160 patient-years of follow-up, the researchers found that the rate hospitalization for diabetic ketoacidosis was lower in patients in the pump cohort vs. the control group (2.3 vs. 4.7 per 100 patient-years; P=.003).
“This magnitude of change is clinically significant, as the [Diabetes Control and Complications Trial] has reported reductions in microvascular complications of 21% to 49% with every 1% reduction in HbA1c,” the researchers wrote.
Disclosure: The researchers report no relevant financial disclosures.
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