2016, Number 1
<< Back Next >>
Rev Med Inst Mex Seguro Soc 2016; 54 (1)
Indications for the use of continuous subcutaneous insulin infusion in pediatric patients with type 1 diabetes mellitus
Espejel-Huerta D, Antillón-Ferreira CA, Iglesias-Leboreiro J, Bernárdez-Zapata MI, Martínez-Ramos Méndez A, Rendón-Macías ME
Language: Spanish
References: 19
Page: 64-69
PDF size: 258.91 Kb.
ABSTRACT
Background: Diabetes is a serious health problem for pediatrics. In pediatric
patients control depends on correct insulin administration. The most
usual is subcutaneous administration according to the glycemic control.
The aim was to analyze the indications for continuous subcutaneous insulin
infusion (CSII) in type 1 diabetes mellitus (T1DM) children and adolescents.
Methods: It was carried out a descriptive study in patients from 1 to 16
years with T1DM who underwent CSII therapy. The main cause to use
this therapy was analyzed, and also if that cause was different regarding
age, sex and disease progression.
Results: 61 patients underwent CSII therapy. The median age at the
beginning of treatment was 9 years old; 43 patients (71.6 %) had more
than one year of diagnosis. The main reasons to use CSII were: 42.6 %
had to improve their quality of life, 34.4 % had to reduce the high glycemic
variability, 13.1 % had to control severe recurrent hypoglycemia,
and 9.8 % had to control their HbA1c. For children under 6 years of age
(
n = 14) the more frequent indication were recurrent hypoglycemia and
to improve their quality of life; children from 6 to 12 years of age (
n = 27)
had to improve their quality of life, and in children over 12 years CSII
was indicated for high glycemic variability and severe recurrent hypoglycemia.
There was no different indication related between sexes.
Conclusion: Improve their quality of life and reach a better glycemic
control were the main reasons to start CSII in our patients.
REFERENCES
[No authors listed]. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. N Engl J Med. 1993;329:977-86.
Nathan DM, Cleary PA, Backlund JY, Genuth SM, Lachin JM, Orchard TJ, et al. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med. 2005;353:2643-53.
Tamborlane WV, Sherwin RS, Genel M, Felig P. Reduction to normal of plasma glucose in juvenile diabetes by subcutaneous administration of insulin with a portable infusion pump. N Engl J Med. 1979;300:573-8.
Phillip M, Battelino T, Rodriguez H, Danne T, Kaufman F. Use of insulin pump therapy in the pediatric age-group: consensus statement from the European Society for Paediatric Endocrinology, the Lawson Wilkins Pediatric Endocrine Society, and the International Society for Pediatric and Adolescent Diabetes, endorsed by the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2007;30:1653-62.
Handelsman Y, Mechanick JI, Blonde L, Grunberger G, Bloomgarten ZT, Bray GA, et al. American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for developing a diabetes mellitus comprehensive care plan. Endocr Pr Off J Am Coll Endocrinol Am Assoc Clin Endocrinol. 2011;17 Suppl 2: 1-53.
Ahern JAH, Boland EA, Doane R Ahern JJ, Rose P, Vincent M, et al. Insulin pump therapy in pediatrics: a therapeutic alternative to safely lower HbA1c levels across all age groups. Pediatr Diabetes. 2002;3:10-5.
Weinzimer SA, Ahern JH, Doyle EA, Vincent MR, Dziura J, Steffen AT, et al. Persistence of benefits of continuous subcutaneous insulin infusion in very young children with type 1 diabetes: a follow-up report. Pediatrics. 2004;114:1601-5.
Weissberg-Benchell J, Antisdel-Lomaglio J, Seshadri R. Insulin pump therapy: a meta-analysis. Diabetes Care. 2003;26:1079-87.
Litton J, Rice A, Friedman N, Oden J, Lee MM, Freemark M. Insulin pump therapy in toddlers and preschool children with type 1 diabetes mellitus. J Pediatr. 2002;141:490-5.
Eugster EA, Francis G. Lawson-Wilkins Drug and Therapeutics Committee. Position statement: Continuous subcutaneous insulin infusion in very young children with type 1 diabetes. Pediatrics. 2006; 118:e1244-9.
Continuous subcutaneous insulin infusion for the treatment of diabetes mellitus | Guidance and guidelines | NICE. Disponible en http://www.nice.org.uk/guidance/ta151
12 .Blackman SM, Raghinaru D, Adi S, et al. Insulin pump use in young children in the T1D Exchange clinic registry is associated with lower hemoglobin A1c levels than injection therapy. Pediatr Diabetes. 2014; published online Feb 4. DOI:10.1111/pedi.12121.
13 .Peters JE, Mount E, Huggins CE, Rodda C, Silvers MA. Insulin pump therapy in children and adolescents: changes in dietary habits, composition and quality of life. J Paediatr Child Health. 2013;49:E300-5.
Sulli N, Shashaj B. Continuous subcutaneous insulin infusion in children and adolescents with diabetes mellitus: decreased HbA1c with low risk of hypoglycemia. J Pediatr Endocrinol Metab JPEM. 2003;16:393-9.
15 . Bode BW, Steed RD, Davidson PC. Reduction in severe hypoglycemia with long-term continuous subcutaneous insulin infusion in type I diabetes. Diabetes Care. 1996;19:324-7.
Hofer S, Meraner D, Koehle J. Insulin pump treatment in children and adolescents with type 1 diabetes. Minerva Pediatr. 2012;64:433-8.
17 . Frøisland DH, Graue M, Markestad T, Skrivarhaug T, Wentzel-Larsen T, Dahl-Jørgensen K. Health-related quality of life among Norwegian children and adolescents with type 1 diabetes on intensive insulin treatment: a population-based study. Acta Paediatr Oslo Nor 1992. 2013;102:889-95.
American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2012; 35 Suppl 1:S64-71.
St Charles M, Lynch P, Graham C, Minshall ME. A costeffectiveness analysis of continuous subcutaneous insulin injection versus multiple daily injections in type 1 diabetes patients: a third-party US payer perspective. Value Heal J Int Soc Pharmacoeconomics Outcomes Res. 2009;12:674-86.