medwireNews: The introduction of insulin pump therapy soon after the diagnosis of Type 1 diabetes does not adversely affect quality of life or hypoglycaemia risk and may also improve long-term glucose control, study findings suggest.
The researchers found that 38 children who started using an insulin pump within 30 days of diagnosis had glycated haemoglobin (HbA1c) levels averaging 6.8% (51 mmol/mol) across the first 48 months of pump use.
This was significantly lower than the 7.9% (63 mmol/mol) observed in 37 children who used multiple daily injections for at least 12 months before switching to insulin pump therapy.
The same glucose control benefits were observed for children younger than 13 years of age (HbA1c 6.9 vs 8.0%) and for those aged 13 years or older (6.7 vs 7.9%). The team therefore believes that early use of an insulin pump “is a valid treatment in both the prepubertal and adolescent age groups”, although they stress that the findings need to be confirmed in a larger prospective study.
Researcher Deborah Foskett (Insulin Pump Angels, Helensvale, Queensland, Australia) and colleagues note that patients with a delayed start to insulin pump therapy were younger than those with an immediate start. They were aged an average of 4.9 years at diagnosis but did not start to use a pump until they were almost 9 years old – the same age at which the early start group were both diagnosed and started on insulin pump therapy.
“The age at diagnosis is important in that older children usually receive primary diabetes education along with their parents”, they write in Pediatric Diabetes. But they add that children with a delayed start were re-educated in diabetes management at the time of insulin pump initiation, reducing “the risk of a knowledge bias between the two groups.”
Regardless of how soon after diagnosis they started, all children experienced a reduction in Hb1Ac levels from the point of insulin pump therapy initiation. Insulin requirements were similar between the two groups.
Early initiation had no significant impact on adverse outcomes, with 13% of patients overall experiencing severe hypoglycaemia at some point during follow-up. And quality of life was also unaffected by early introduction of an insulin pump, with 82% of all patients completing the Paediatric Quality of Life Inventory and the Diabetes Module Inventory, and reporting high levels of treatment satisfaction.
By Eleanor McDermid, Senior medwireNews Reporter
Pediatr Diabetes 2016; Advance online publication
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