Endocrine Abstracts

Introduction: Tight metabolic control reduces the risk of microvascular complications in individuals with type 1 diabetes (T1DM). Multiple studies have shown improvements in quality of life (QOL) in children following the introduction of continuous subcutaneous insulin infusion (CSII) but metabolic outcomes have been more variable. This audit looked at metabolic parameters at long-term follow up in children and adolescents using CSII over 3 years.

Methods: Fifty-seven children and adolescents are using CSII therapy in our unit with greater than one year follow up post pump initiation available for 45 patients (median age 14.2 years, twenty-three males). Data was collected prospectively on all children on HbAlc, incidence of severe hypoglycaemia and diabetic ketoacidosis, as well as anthropometric data.

Results: The median duration of diabetes was 7.4 years (range 1–19.2 years), median duration using CSII was 2.7 years (range 1–4.5 years). Mean HbAlc decreased from 8.9% at commencement to 8.1% at 1 year (n=45, P<0.001), 8.1% at 2 years (n=36, P<0.001) and continued to decrease to 7.9% at 3 years (n=23, P<0.001) post pump initiation. Mean BMI z-score remained stable throughout the follow up period. There were thirteen severe hypoglycaemic episodes documented in this cohort in the year prior to pump commencement compared to one episode (due to an accidental insulin overdose) in the three years of follow up. The incidence of DKA was low but fell further during pump therapy (two episodes in the year prior to pump therapy versus two episodes in 3 years of follow up).

Conclusion: Continuous subcutaneous insulin infusion therapy is safe and effective in children and adolescents and is associated with sustained improvements in metabolic control and reductions in adverse outcomes without negative impacts on BMI.