Insulin pumps give better glycaemia outcomes for children than MDI

Children with type 1 diabetes using an insulin pump have better glycaemic control than to those using multiple daily injections (MDI) of insulin, an Australian study shows.

In what’s described as the largest and longest real-world follow up study of insulin regimens in children with T1D, pump therapy was associated with consistently lower HbA1c for up to a decade of follow up.

And the findings, based on WA diabetes registry data for more than 1000 children , also showed that improved glycaemic control was achieved with lower doses of insulin and with no increase in risk of severe hypoglycaemia or DKA.

Lead investigator Dr Marie-Anne Buckhardt and colleagues from the Children’s Diabetes Centre at the Telethon Kids Institute in Perth compared outcomes for 513 children using insulin pumps and a similar number of matched children using insulin injection therapy.

A difference in HbA1c became evident within six months of starting pump therapy, which was initially 0.3% lower for pump therapy than for insulin injections.

After the first year both pump and injection users showed a gradual increase in mean HbA1c over time, but the mean difference over time was 0.4% and remained significant.

The cohort of children who used a pump had higher rates of severe hypoglycaemia before starting compared to the injection cohort (more than double that of the injection cohort), but both groups then had similar rates (6.3 vs 5.7 events per 100 patient years) during follow up. Rates of readmission for both cohorts were similar.

And while both groups had a similar mean total daily insulin dose initially, a difference was seen within six months for pump vs injection therapy (0.79 vs 0.96 U/kg/day). The difference decreased over time but remained significantly lower for pump vs injection (0.93 vs 1.03 U/kg/day at eight years).

The researchers, who also included  endocrinologist Professor Elizabeth David of the Perth Children’s Hospital, said the 0.4% mean difference in HbA1c between the pump and injection cohorts was clinically significant, particularly in the context of long term complications with T1D.

They said the findings were also important because they were based on real world data and showed that the short term improvements in glycaemia seen with insulin pumps in randomised controlled trials were maintained in the longer term.

However they cautioned that the findings were derived from the era prior to the widespread use of CGM.

“As T1D management for both those on injection and pump therapy improves with time through the knowledge gained from better technology, lower target blood glucose ranges/levels, increased education around blood glucose adjustments, carbohydrate counting, and education about how different foods such as fat and protein influence glycaemia, it remains to be seen whether the difference in outcomes between pump and injection therapy is sustained,” they wrote.

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