Endocrine Abstracts

Background: Current NICE guidance states that insulin pump therapy (CSII) can be considered in Type 1 diabetes (T1DM) patients who suffer disabling hypoglycaemia in an attempt to reach glycaemic control or whose HbA1C remains high (>69 mmol/l) despite careful management on multiple daily injections (MDI).

Aims: Our aims were to determine impact of CSII therapy on glycaemic control, BMI, incidence of severe hypoglycaemia and episodes of diabetic ketoacidosis (DKA).

Methods: Retrospective study on paediatric patients commenced on CSII between 2010 and 2014 at Nottingham Children’s Hospital (NCH). Mean age at pump start, indications for therapy, duration of diabetes and HBA1c and BMI at baseline, 6 and 12 months post CSII, episodes of hypoglycaemia and DKA were collected.

Results: In total of 79 patients commenced pump therapy. 65 patients (35 male) were included with a mean age at diagnosis (5.9±3.8), pump start (average 9.3±3.5, range 1.8–15.6), duration of diabetes (3.4±2.3, range 0.5–9.9) respectively. Indications for pump therapy included frequent hypoglycaemia (16), poor control on MDI (13) and not documented (22). There were no episodes of severe hypoglycaemia reported in the four years post pump therapy and the DKA hospitalisation rate was 4.6%.

Overall HbA1c improved at 6 months (62.95±10.2 vs 58.95±8.9, P=0.02) however this was not maintained at 12 months (61.51±11.7, P=0.45). Sub-group analysis revealed that this improvement in HbA1c was only evident in the male population (P=0.013). Overall BMI did not differ at follow-up; similarly, subgroup analyses revealed male and female BMI did not differ from baseline.

Conclusion: In our cohort of patients (n=65) CSII therapy was only associated with short-term improvements in HbA1c of male patients. Further follow up is on going.