Current goals for the treatment of children and adolescents with type 1 diabetes mellitus include achieving near-normal blood sugar levels, minimizing the risk of hypoglycemia, optimizing quality of life, and preventing or delaying long-term microvascular and macrovascular complications. Continuous subcutaneous insulin infusion (CSII), or insulin pump therapy, provides a treatment option that can assist in the attainment of all of these goals in all ages of children. In pediatric patients, CSII has been demonstrated to reduce both glycosylated hemoglobin levels and frequency of severe hypoglycemia, without sacrifices in safety, quality of life, or weight gain, particularly in conjunction with the use of new insulin analogs and improvements in pump technology. Clinical studies of safety and efficacy of CSII in children are reviewed, as well as criteria for patient selection and practical considerations using pump therapy in youth with T1DM.
"The main goals for managing children with type-1-diabetes mellitus include achieving near-normal blood sugar levels, minimizing hypoglycemic incidents, optimizing quality of life, and preventing or delaying long-term complications. Continuous subcutaneous insulin infusion (CSII) is a treatment option that can assist in achieving all of these goals in all ages of children . European Union countries reimburse insulin therapy for individuals with health insurance, but for CSII reimbursement, a variety of approaches exist [5-7]. "
[Show abstract][Hide abstract] ABSTRACT: The objective of this study is to assess the cost of using continuous subcutaneous insulin infusion to treat children with type-1diabetes in Bulgaria, considering changes in body mass index (BMI) and the glycated hemoglobin. The study was performed from the perspective of the Bulgarian National Health Insurance Fund (NHIF) and patients.
A total of 34 pediatric type-1-diabetes patients were observed for 7 months, divided into 2 groups -- on pumps and on insulin analogue therapy. Patient demographic data, BMI and glycated hemoglobin level were obtained and recorded. The cost of insulin, pumps, and consumables were calculated and compared with changes in glycated hemoglobin level. The incremental cost-effectiveness ratio was below the threshold value of gross domestic product per capita.
The results were sensitive to changes in glycated hemoglobin level. Improvements associated with glycemic control led to a reduced glycated hemoglobin level that could ensure good diabetes management, but its influence on BMI in growing children remains unclear.
Continuous subcutaneous insulin infusion appears to be more cost-effective for the Bulgarian pediatric population and health care system.
"The main goals for managing children with type-1-diabetes mellitus include achieving normal blood sugar levels, minimizing hypoglycemic incidents, optimizing quality of life, and preventing or delaying long-term complications . Continuous subcutaneous insulin infusion (CSII) is a treatment option that can assist in achieving all of these goals in all ages of children . European Union countries reimburse insulin therapy for individuals with health insurance, but for CSII reimbursement, a variety of approaches exist   . "
[Show abstract][Hide abstract] ABSTRACT: The aim of this study is to assess long-term metabolic outcomes in children with diabetes mellitus and to compare the efficacy, feasibility and metabolic control expenses for treatment with continuous subcutaneous insulin infusion (CSII), compared to human insulin treatment. The study sample included 34 children aged 3 to 18 years with type 1 diabetes, 17 with continuous subcutaneous insulin infusion (CSII) therapy and 17 with standard treatment with human insulin. The study observed for the following variables: duration of the disease, diabetic control, HbA1c deviation scores; height and weight deviation and price of the treatment. Methods applied include meta-analyses in the published medical lit-erature, pharmacoeconomic analysis and statistical analysis. From the 34 children with diabetes type 1 observed retro-spectively during the period 1999-2012, 17 were on CSII (mean age 10 years, mean duration of the disease—7 years, average usage of CSII—3 years). The test stripes cost 533 Euro/year (1100 stripes per year) and their average cost ac-cording to the duration of the disease is 3779.45 Euro since diagnosis. The blood glucose monitoring system costs 20 Euro and for the duration of the disease—4.96 Euro per patient per year. The average improvement of HbA(1c) after the CSII introduction is 1.85, while after the application of human insulin—0.28. The treatment with CSII leads to signifi-cant improvement in glycemic control compared to the treatment with human insulin. The reduced HbA(1c) shows good diabetes management, from one point of view, and good quality of life—from another.
Modern Economy 01/2013; 4(10):9-13. DOI:10.4236/me.2013.410A002
"The goals for treatment of children and adolescents with type 1 DM are twofold: first, to achieve stable glycaemic control and second, to prevent or delay the occurrence of lifethreatening complications associated with ketoacidosis (Robert et al. 2007). These goals include reducing the risk of hypoglycaemia and preventing or delaying long-term microvascular and macrovascular complications (Tamborlane et al. 2006). The focus of care for patients with DM is to optimise their quality of life (Hart et al. 2007). "
[Show abstract][Hide abstract] ABSTRACT: To explore the effects of exercise programme on glycosylated haemoglobin and peak oxygen uptake in children and adolescents with type 1 diabetes mellitus.
Regular exercise has been shown to be effective in blood glucose control, which includes improving glucose tolerance and insulin sensitivity, decreasing glycosylated haemoglobin levels and improving cardiorespiratory fitness.
Quasi-experimental design with a twelve-week home-based aerobic exercise programme.
Twenty-eight participants completed the study: 12 in the home-based exercise group, 11 in the non-exercise control group and five in the self-directed exercise group. A mixed model was used to capture longitudinal change in glycosylated haemoglobin levels.
The home-based aerobic exercise group showed no significant effect on glycemic control and peak oxygen uptake in this study across assessment times. However, a group difference in glycosylated haemoglobin levels at the nine-month follow-up was significant (general linear model: F = 4.06, p = 0.03). A Bonferroni test indicated that glycosylated haemoglobin levels in the home-based exercise group were higher than in the self-directed exercise group (p < 0.05) and higher in the control group than in the self-directed exercise group (p < 0.05) at the nine-month follow-up. Home-based aerobic exercise showed no significant effect on peak oxygen uptake in this study.
A three-month home-based aerobic exercise programme has no significant effect on glycosylated haemoglobin and peak oxygen uptake levels in children with type 1 diabetes mellitus.
Our exercise programme has designed that children can practice exercise at home and is a viable component of self-care intervention to improve patient's self-care skill and diabetes care control. However, how to encourage patients to adhere the exercise programme is a challenge for health care providers.
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