Insulin Pump Treatment of Childhood Type 1 Diabetes

Department of Pediatrics, Yale University, New Haven, Connecticut, United States
Pediatric Clinics of North America (Impact Factor: 2.12). 01/2006; 52(6):1677-88. DOI: 10.1016/j.pcl.2005.07.004
Source: PubMed


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 complications. Continuous subcutaneous insulin infusion (CSII) provides a treatment option that can assist in the attainment of all of these goals in all ages of children. Usage of CSII has been demonstrated to reduce 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.

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Available from: Amy Steffen, Dec 23, 2014
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    • "The American Diabetes Association (Silverstein et al., 2005) now recommends that all youth over the age of 7 years be managed with flexible regimens. Such regimens include the use of insulin pumps (continuous subcutaneous insulin infusion) and basal-bolus injectable insulin (Weinzimer, Sikes, Steffen, & Tamborlane, 2005). Self-management is important to the overall management of the disease and becomes even more important as individuals and families make the complex (and frequent) management decisions that flexible regimens demand. "
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    ABSTRACT: The purpose of this paper was to identify and critique relevant existing instruments designed to measure self-management of type 1 diabetes in children and adolescents. Literature on the self-management of type 1 diabetes in children and adolescents was systematically searched to identify instruments measuring self-management. After eliminating instruments that measured only one aspect of self-management, those published prior to DCCT findings, and those for which little information was available, 6 instruments were identified for review. Each instrument is discussed in terms of history and description of the instrument, definitions, psychometrics, findings from studies using the instrument, availability of the instrument, and evaluation. All of the instruments measure some of the activities of self-management; 1 expressly measures self-management; 1 measures the frequency of various self-care activities, and 4 measure adherence to prescribed diabetes regimens. Only 1 instrument comprehensively assesses the process of self-management. None measure the goals of self-management. Instrument development has been hindered by the lack of clarity concerning the concept of self-management of type 1 diabetes in children and adolescents. Existing measures need to be further developed and new measures need to be designed.
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    ABSTRACT: The incidence of type 1 diabetes is increasing world wide, especially in younger children. Unfortunately, there is little information on the incidence of type 1 diabetes or its management from India. Recent studies have emphasized the importance of strict glycemic control in the prevention and delay of chronic microvascular complications of diabetes mellitus. This has lead to increasing efforts in devising means of physiological insulin delivery, in which basal insulin and meal related boluses of insulin are separately given and insulin doses are appropriately altered based on frequent blood glucose testing, meal size and exercise. Newer insulin analogues, which better mimic basal and meal related increments of insulin secretion, have been marketed. Regimes for physiological insulin delivery, such as multiple subcutaneous insulin injections and continuous subcutaneous insulin infusion are becoming increasingly popular. However, the high frequency of hypoglycemia is an important constraint to achieving normal glycemic control. In developing countries such as India, other obstacles include the high cost of insulin and blood glucose monitoring strips, social barriers to accepting insulin injections and lack of trained teams for management of type 1 diabetes.
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