Three-year comparison of subcutaneous insulin pump treatment with multi-daily injections on HbA1c, its variability and hospital burden of children with type 1 diabetes.

Department of Paediatrics, Oncology, Haematology and Diabetology, Medical University of Lodz, 36/50 Sporna St., 91-738, Lodz, Poland.
Acta Diabetologica (Impact Factor: 4.63). 10/2011; 49(5):363-70. DOI: 10.1007/s00592-011-0332-7
Source: PubMed

ABSTRACT Treatment with continuous subcutaneous insulin infusion (CSII) allows a large degree of treatment individualization and intensification in children with diabetes. The study's aim was to evaluate the impact of treatment with CSII on glycated haemoglobin level (HbA1c) in children with diabetes and investigate whether introduction of CSII is associated with an increased risk of acute complications of diabetes. Patients treated throughout the recruitment period exclusively with multiple daily injections (MDI) were matched for duration of diabetes and HbA1c level at baseline with patients treated exclusively with CSII in a 1:1 group ratio (n = 223 and 231 for MDI and CSII, respectively). The CSII group showed lower HbA1c after the observation period (7.98 ± 1.38 vs. 7.56 ± 0.97; P = 0.002). HbA1c variability measured as standard deviations of average values was also lower in the CSII group (0.73 ± 0.45 vs. 0.84 ± 0.54; P = 0.049). The rate of hospitalization due to acute events was similar in both groups (14.7/100 vs. 14.0/100 person/years in the MDI and CSII group, P = 0.72). Duration of hospital stay per year was on average 1.25 days shorter in the CSII group (P = 0.0004), but the risk of acute complications resulting in hospitalization did not differ between the groups (hazard ratio (HR) 1.16; 95% confidence interval (95% CI) 0.68-1.63). The most significant risk factor for hospitalization due to acute complications was baseline HbA1c concentration (HR 1.25; 95% CI 1.14-1.37). In conclusion, CSII treatment may improve glycemic control and reduce its variability. Change of MDI to CSII does not alter the risk of hospitalization and may reduce the annual duration of hospitalization in children with diabetes.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE To compare the diagnostic accuracy and time expenditure of screening models based on glycated hemoglobin (HbA(1c)) level and psychometric measures for mood disorder (MD) among children with type 1 diabetes. RESEARCH DESIGN AND METHODS With semistructured clinical interviews (Schedule for Affective Disorders and Schizophrenia for Children-Present and Lifetime version, 120 min/patient) as a reference for diagnosing MD, including major depressive disorder (MDD), we tested 163 subjects, aged 8 to 18 years, with type 1 diabetes. We evaluated four screening approaches: 1) Children's Depression Inventory (CDI) at 30 min/patient, 2) HbA(1c) level, 3) HbA(1c) level plus CDI, and 4) HbA(1c) level plus Children's Depression Rating Scale (CDRS) at 40 min/patient. These tests were conducted with all participants, and the total time expenditure for all four approaches was calculated as the total time needed to implement successfully the screening for MD or MDD in the center. RESULTS HbA(1c) performed on par with individual psychometric tests in diagnosing MD or MDD. The HbA(1c) plus CDRS model was the best screening procedure for both MD and MDD, with diagnostic thresholds for HbA(1c) established at 8.7% and 9.0%, respectively. Cutoff points for CDRS assessed after filtering by HbA(1c) were 26 (MD) and 30 (MDD) points. Center-wide application of this procedure would result in an 83% reduction of the examination time necessary for the psychiatrist for MD screening and a 91% reduction for MDD screening, as compared with standard screening with CDI. CONCLUSIONS Use of HbA(1c) level followed by CDRS is a time-efficient procedure to screen for MD in children with type 1 diabetes.
    Diabetes care 09/2012; 35(11):2133-9. · 7.74 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Islet transplantation is one of the most promising and effective therapies for restoring normoglycemia in type 1 diabetic (T1D) patients but islet engraftment is one of the main obstacles hampering long-term success. Monitoring graft loss, caused either by immunological or non-immunological events, occurring in the first phase after transplantation and at later stages of patient’s life is a very important issue. Among the imaging approaches previously applied Magnetic Resonance Imaging (MRI) monitoring of islets fate following labeling with superparamagnetic iron oxide agents resulted promising. Aim of this study was to translate into patients the method of islet labeling and MRI monitoring developed in our preclinical setting, and to compare imaging results with graft clinical outcome. Three T1D patients and one non-diabetic patient undergoing auto-transplantation following subtotal pancreasectomy received Endorem®-labeled islets. Patients were monitored by MRI and metabolically (HbA1C, exogenous insulin requirement and C-peptide, TEF) at 1, 3, 7 days following transplantation and once a month up to ten months. Labeled transplanted islets appeared as hypointense areas scattered within the liver parenchyma, whose absolute number at 24hr after transplantation reflected the labeling efficiency. In Pt#1 and 3 with good mid-term graft function, MRI follow-up showed an important early loss of hypointense spots followed by a slow and progressive disappearance at later time points. Graft loss of function in Pt#2 4 weeks after transplantation was associated with the complete disappearance of all hypointense signals. The auto-transplanted patient stably insulin free, showed no significant signal reduction during the first 3 days, followed by loss of spots similar to Pt with good mid-term graft function. These results suggest that MRI monitoring of islet transplantation at early time points could represent a meaningful read-out for helping in predicting transplant failure or success, but its relevance for mid-/long-term islet function assessment appears evanescent.
    Cell Transplantation 08/2014; · 4.42 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Carbohydrate counting (CHC) in combination with nutritional education has been used to optimize the insulin dose in patients with type 1 diabetes (T1D). The aim of this study was to test the impact of CHC and nutritional education on changes in dietary habits, body composition and body fat distribution in children with T1D treated with insulin pumps (CSII). Twenty-five children with T1D and CSII were recruited and valuated at baseline and after 18 months of follow-up. They were trained in CHC and following standard nutrition education program (based on American Diabetes Association and International Society of Pediatric and Adolescent Diabetes guidelines); clinical, biochemical and nutritional variables were measured. In the total population, body composition, body fat distribution and biochemical variables did not change, at follow-up; HbA1c was significantly reduced (8.50 ± 0.77 vs 7.92 ± 0.74 %; p < 0.001) without changing insulin/kg/day requirement. In the sub-group of patients with a significant HbA1c reduction (ΔHbA1c ≥ 0.5 %, n = 12), the carbohydrate (CHO) intake was significantly higher at follow-up (53.0 ± 4.0 vs 57.6 ± 2.5 %; p < 0.01); on the contrary, fat (31.3 ± 3.6 vs 28.5 ± 1.6 %; p < 0.05) and protein intake (15.4 ± 1.8 vs 13.3 ± 1.6 %; p < 0.01) significantly decreased. Patients without a significant HbA1c reduction did not show any difference. CHC, in combination with nutritional education, does not affect dietary habits, body composition and body fat distribution in children with T1D treated with CSII. Moreover, the sub-group of subjects showing a significant improvement in glycometabolic control reported an increase in CHO intake and a reduction in fat and protein intake.
    Acta Diabetologica 06/2013; · 4.63 Impact Factor


1 Download
Available from