The effect of insulin infusion pump application on clinical and metabolic parameters in adolescents with type 1 diabetes

THE EFFECT OF INSULIN INFUSION PUMP APPLICATION ON CLINICAL ANDMETABOLIC PARAMETERS IN ADOLESCENTS WITH TYPE 1 DIABETESSummaryObjective: To compare the long-term outcomes of insulin pump application with theclinical and metabolic parameters recorded during multiple daily insulin therapy andto assess the efficiency and complications of insulin pump application in adolescentswith type 1 diabetes.Material and method: Type 1 diabetic adolescents, in whom insulin pump wasapplied between 2002 and 2006 in the Department of Paediatric Endocrine andAdolescence in Dokuz Eylül University, were enrolled in the study. Insulin infusionpump was inserted to volunteer adolescents who had a duration of diabetes for atleast 2 years, regularly attended polyclinic controls for the last one year, measuredand recorded blood glucose average 3 to 4 times a day, did not achieve thepreferred metabolic control despite multiple insulin injection treatment (pre-mealanalogue or short-acting insulin + NPH one or two times a day) and had the ability ofcarbohydrate counting and performing. The patients were investigated under threeperiods: multiple daily insulin injections (non-flexible period), multiple daily insulininjections and carbohydrate counting (transition or flexible period) and insulininfusion pump period. The frequency of hypoglycaemia and diabetic ketoacidosis(episode/patient/year), HbA1c levels, total insulin requirement, basal/bolus insulinratios, lipid profiles, glucose levels and BMI SDS in the insulin infusion pump periodwere compared with the data of flexible and non-flexible multiple daily insulininjection periods. Friedman variance analysis was used to compare the metabolicand clinical parameters and p <0.05 was considered as statistically significant.Results: The mean age of insulin pump insertion and the duration of diabetes,flexible multiple daily insulin injections and insulin pump use of 17 adolescentpatients (8 female, 9 male) who were enrolled in the study were 15.53±1.8,6.77±4.05, 0.70±0.20, 2.07±1.12 years, respectively. A decrement was detected inHbA1c levels of the patients with transition to insulin pump compared to flexible andmultiple daily insulin injection periods, however this decrease was not statistically3significant (7.71%, 8.21%, and 8.71%, respectively, p=0.105). No significantdifferences were detected regarding BMI SDS, lipid profiles, total insulinrequirement, and basal/bolus insulin ratios of the patients when the data?s of post-pump state were compared with flexible and non-flexible multiple daily insulininjection periods (p> 0.05). Although a trend of increased risk for hypoglycaemia wasdetected with transition to insulin pump application, no statistical difference wasobserved when compared to flexible and non-flexible multiple daily insulin injectionperiods regarding hypoglycaemia (21.78, 19.02, 15.4 (episode/patient/year),respectively, p=0.497). With transition to insulin pump application, statisticallysignificant decrease was detected in the mean glucose levels when compared toflexible and non-flexible multiple daily insulin injection periods (154.66, 171.91,199.41 mg/dL, respectively, p=0.002). During insulin pump period, none of ourpatients had diabetic ketoacidosis.Conclusion: In the adolescent age group, it is revealed that insulin pump treatmentis efficient and safe without an increased risk of weight gain, diabetic ketoacidosis,and hypoglycaemia compared to flexible and non-flexible multiple daily insulininjections. The present study also demonstrated that flexible multiple insulin injectiontreatment together with carbohydrate counting should be used efficiently and safelyin patients who could not receive insulin pump treatment because of social andfinancial causes.Key words: Type 1 diabetes mellitus, Insulin pump treatment, adolescent4