Characterization of metabolic responders on CSII treatment amongst children and adolescents in Denmark from 2007 to 2013

TY - JOUR

T1 - Characterization of metabolic responders on CSII treatment amongst children and adolescents in Denmark from 2007 to 2013

AU - Overgaard Ingeholm, I

AU - Svensson, J

AU - Olsen, B

AU - Lyngsøe, L

AU - Thomsen, J

AU - Johannesen, J

AU - DSBD

N1 - Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

PY - 2015/8/1

Y1 - 2015/8/1

N2 - Aim: This prospective study aimed to identify and estimate the frequency of responders offered Continuous subcutaneous insulin infusion (CSII) from baseline data and during follow-up, and secondly to characterize CSII users with good adherence to pump therapy among 463 children and adolescents with Type 1 diabetes mellitus. Methods: A response was defined as lowering HbA1c with 1% or achieving an HbA1c<7.5% (58mmol/mol). Good adherence was defined as measuring ≥7 self monitored blood glucoses (SMBGs) and taking ≥7 boluses daily. Logistic regression was used to estimate the effect of demographic and clinical variables prior to and during pump treatment. Results: At 24 months follow-up 32% qualified as responders. Stratifying for age at onset, 45% of the children aged <6yrs qualified as responders vs. 32% and 28% of the youngsters and adolescents aged 6-12yrs. and 12-19 yrs., respectively (p=0.02). Responders were characterized by their HbA1c-level at pump onset (p=0.001), taking more daily boluses (7.64±3.33 vs. 6.40±3.18 p=0.003) and measuring more SMBGs per day at follow-up (6.88±2.35 vs. 6.31±2.54 p=0.03). The incidence of severe hypoglycemia decreased from 14.3 to 3.3 events per 100 person years (p<0.0001). Twenty percent did not respond despite a good adherence toward CSII therapy. Conclusion: Age <6 years, high or low HbA1c at pump initiation and number of daily boluses were associated with improved or sustained near-normal metabolic outcome. The incidence of severe hypoglycemia was significantly reduced. Twenty percent of the population had good adherence without any metabolic improvement.

AB - Aim: This prospective study aimed to identify and estimate the frequency of responders offered Continuous subcutaneous insulin infusion (CSII) from baseline data and during follow-up, and secondly to characterize CSII users with good adherence to pump therapy among 463 children and adolescents with Type 1 diabetes mellitus. Methods: A response was defined as lowering HbA1c with 1% or achieving an HbA1c<7.5% (58mmol/mol). Good adherence was defined as measuring ≥7 self monitored blood glucoses (SMBGs) and taking ≥7 boluses daily. Logistic regression was used to estimate the effect of demographic and clinical variables prior to and during pump treatment. Results: At 24 months follow-up 32% qualified as responders. Stratifying for age at onset, 45% of the children aged <6yrs qualified as responders vs. 32% and 28% of the youngsters and adolescents aged 6-12yrs. and 12-19 yrs., respectively (p=0.02). Responders were characterized by their HbA1c-level at pump onset (p=0.001), taking more daily boluses (7.64±3.33 vs. 6.40±3.18 p=0.003) and measuring more SMBGs per day at follow-up (6.88±2.35 vs. 6.31±2.54 p=0.03). The incidence of severe hypoglycemia decreased from 14.3 to 3.3 events per 100 person years (p<0.0001). Twenty percent did not respond despite a good adherence toward CSII therapy. Conclusion: Age <6 years, high or low HbA1c at pump initiation and number of daily boluses were associated with improved or sustained near-normal metabolic outcome. The incidence of severe hypoglycemia was significantly reduced. Twenty percent of the population had good adherence without any metabolic improvement.

KW - Adolescent

KW - Blood Glucose Self-Monitoring

KW - Child

KW - Denmark

KW - Diabetes Mellitus, Type 1

KW - Female

KW - Hemoglobin A, Glycosylated

KW - Humans

KW - Hypoglycemic Agents

KW - Incidence

KW - Injections, Subcutaneous

KW - Insulin

KW - Insulin Infusion Systems

KW - Male

KW - Prospective Studies

U2 - 10.1016/j.diabres.2015.05.027

DO - 10.1016/j.diabres.2015.05.027

M3 - Journal article

C2 - 26070217

SN - 0168-8227

VL - 109

SP - 279

EP - 286

JO - Diabetes Research and Clinical Practice

JF - Diabetes Research and Clinical Practice

IS - 2

ER -