Insulin pumps help hard-to-treat teenagers with poor glycaemic control

Type 1 diabetes

By Mardi Chapman

12 Apr 2018

Insulin pump therapy has been shown to improve HbA1c in teenagers with type 1 diabetes and very poor glycaemic control.

The small cohort of 10 patients from the Princess Margaret Hospital in Perth each had a baseline HbA1c of >10% before commencing a comprehensive education program followed by an insulin pump.

A maximal HbA1c reduction of 3% was achieved after three months on pump however it gradually rose again and plateaued at about 1.5% less than baseline HbA1c.

According to a report in the Journal of Diabetes Science and Technology, three events of diabetic ketoacidosis occurred – all in the one patient.

All but one participant remained on pump therapy for the 12 months of the study and treatment satisfaction was consistently high throughout the study.

Despite the small size and lack of a control arm in the study, the researchers concluded insulin pump therapy combined with flexible education and a supportive framework, can be effective in a hard-to-treat teenage population.

Paediatric endocrinologist Dr Martin de Bock, now at the University of Otago in Christchurch, told the limbic the teenagers nominated themselves for the trial and were therefore ‘motivated for change’.

Many had a history of significant social disadvantage, had never done well with glycaemic control, and had lost faith in the system and services.

“The pump gave them hope and a fresh start. It was a catalyst for change and it did change their lives. We are buying their metabolic health long-term.”

He added that a history of poor control should not be used as a barrier to accessing a pump.

“If they want to change, do what you can to help them break the pattern.”

He said the change in insulin delivery alone was not sufficient however.

“They need the support team to go with it – a diabetes educator and lots of contact time.

Teenagers in the study had four, two-hour education sessions initially, followed by daily contact for a couple of weeks then weekly contact for the first few months.

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