Devices called insulin pumps may work better at controlling blood sugar in children with type 1 diabetes than insulin injections, a new study finds.
They might also cause fewer complications, the Australian researchers said.
"This is the largest study of insulin-pump use in children," wrote a team led by Dr Elizabeth Davis of the Princess Margaret Hospital for Children in Perth. "It also has the longest follow-up period of any study of insulin-pump therapy in children. Our data confirm that insulin-pump therapy provides an improvement in glycaemic control, which is sustained for at least seven years."
The study was published on 18 August in the journal Diabetologia.
Davis's team compared outcomes for 345 children, aged 2 to 19, who were using insulin pumps to control their type 1 diabetes to a similar number of children who were receiving insulin injections.
The children were followed for a median of three and a half years.
During the follow-up period, episodes of dangerously low blood sugar levels (severe hypoglycaemia) in the insulin-pump group fell by about half, the researchers said. In contrast, episodes of severe hypoglyacemia in the insulin-injection group rose, from about seven events per 100 patients per year to more than 10 events by the end of the study.
The researchers also looked at rates of hospital admission for diabetic ketoacidosis, a shortage of insulin that causes the body to switch to burning fats and to produce acidic ketone molecules that cause complications and symptoms. This a frequent complication in children with type 1 diabetes.
Admissions for diabetic ketoacidosis were lower in the insulin-pump group than in the insulin-injection group – 2.3 and 4.7 per 100 patients per year, respectively, according to the study.
Of the 345 patients with insulin pumps, 38 stopped using them at some point during the study: six in the first year, seven in the second year, 10 in the third year and the remainder after three years.
The study authors said some children stop because they tire of the extra attention needed to manage the pump, or are concerned about the physical sight of the pump. Other children sometimes take a temporary "pump holiday" and then start using a pump again.
Two US diabetes experts weren't surprised by the findings.
"The current standard of insulin treatment in type 1 diabetes is multiple daily insulin-injection therapy," said Dr Patricia Vuguin, a paediatric endocrinologist at Cohen Children's Medical Center of New York in New Hyde Park, NY.
"[However], in the 1970s, continuous subcutaneous insulin infusion, also know as pump therapy was introduced," she said. "Pump therapy has been gaining popularity, perhaps because of technical advances resulting in improved patient comfort and improved lifestyle."
Improved and sustained glucose control
Vuguin said the study succeeded in "confirming that insulin-pump therapy improved and sustained glucose control in type 1 diabetic subjects for at least seven years".
Virginia Peragallo-Dittko is executive director of the Diabetes and Obesity Institute at Winthrop-University Hospital in Mineola, New York. She said that "when treating insulin-deficient type 1 diabetes, there is more than one way to provide insulin that mimics what the pancreas usually provides."
"Compared to multiple injections, the insulin pump allows for more flexible insulin dosing when insulin needs decrease during exercise or increase during illness, and it also allows for more flexible meal-time dosing," Peragallo-Dittko said.
What has been missing, however, is a study that tracked children's outcomes with insulin pump use over the long haul, she said.
"The demands of diabetes self-management continue 24/7, and it is especially hard for children, teenagers and their families to manage these demands during growth spurts and puberty," Peragallo-Dittko said. "So what is important about this study is that the improvement in [blood sugar control] lasted over time in a real-life setting and that those who use insulin pumps may have an edge."
The Nemours Foundation has more about type 1 diabetes.
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