Nurses will be interested to read the following article which is contained in Issue 12 -2017 of Paediatrics Research Review titled ‘Association of insulin pump therapy vs insulin injection therapy with severe hypoglycemia, ketoacidosis, and glycemic control among children, adolescents, and young adults with type 1 diabetes Authors: Karges B et al.
This population-based cohort study (the Diabetes Prospective Follow-up Initiative) determined the rates of severe hypoglycaemia and diabetic ketoacidosis in young people with type 1 diabetes using insulin pump therapy compared with insulin injection therapy. From an initial cohort of 30,579 patients aged <20 years
with type 1 diabetes, 9814 patients who were using pump therapy were matched with 9814 patients using injection therapy (≥4 injections per day).
Compared with injection therapy, pump therapy was associated with lower rates of severe hypoglycaemia and diabetic ketoacidosis during the most recent treatment year. Glycated haemoglobin (HbA1c) levels were lower with pump therapy (8.04% vs 8.22%; p<0.001), as were total daily insulin doses (0.84 vs 0.98 U/kg; p<0.001).
I managed dozens of children with type 1 diabetes in a summer camp almost 20 years ago. It was very difficult to maintain tight glycaemic control, particularly in children with variable activity levels. Even then, there were a few children with insulin pumps. This large population cohort study compares outcomes among more than 30,000 children with type 1 diabetes over 5 years.
The study is based on an amazing dataset including most of the children with type 1 diabetes in Germany, Austria and Luxembourg, which minimises sampling bias found in trials where only the most conscientious patients’ consent. The main outcome measures were severe hypoglycaemia and diabetic ketoacidosis, which are important clinical outcomes, but they are proxy measures for long-term outcome measures such as strokes, heart attacks and death.
There were fewer episodes of severe hypoglycaemia and diabetic ketoacidosis across multiple comparisons and adjustments. As a secondary outcome, HbA1c levels were also lower in children on pumps. However, children on pumps also tested their blood glucose levels more often than children on injection therapy. This trial did
not examine sensor-based continuous glucose monitoring coupled with automatic subcutaneous insulin infusion which is the next generation of therapeutic options.
Reference: JAMA 2017;318(14):1358-66′
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