International Society for Pediatric and Adolescent Diabetes
ISPAD 2014 | 40th Anniversary |
229
P139
Continuous subcutaneous insulin infusion versus multiple daily insulin injection in children
with type 1 diabetes in Kuwait: glycemic control, insulin requirement and BMI
M. Abdulrasoul
1
, M. Mousa
2
, M. AlMahdi
3
, H. AlSanaa
4
, D. Al-Abdulrazzaq
5
, H. AlKandari
6
1
Kuwait University Faculty of Medicine, Department of Pediatrics, Kuwait, Kuwait,
2
Kuwait University,
Community Medicine, Kuwait, Kuwait,
3
Adan Hospital, Pediatrics, Kuwait, Kuwait,
4
Amiri Hospital,
Kuwait, Kuwait,
5
Kuwait University Faculty of Medicine, Pediatrics, Kuwait, Kuwait,
6
Farwania Hospital,
Kuwait, Kuwait
Objectives:
The aim of our study was to report experience with CSII in a large cohort of children and
adolescents in comparison with MDI in Kuwait.
Research design and methods:
Patients ≤ 18 years of age started on CSII during the period of July
1
st
2007 until December 31
st
2012 were included. Data collected included gender, age at diagnosis
and at pump insertion, diabetes duration. Body mass index (BMI), hemoglobin A1c (HbA1c), insulin
dose and adverse events were measured at baseline and every 3 months during .Similar data were
collected on patients on MDI followed during the same period.
Results:
Main reason for switching to CSII was to achieve better control. The drop of HbA1c was most
significant in first year of pump therapy, but it continued to be significantly lower in the CSII group
compared to the MDI throughout the study period (CSII 7.94±0.82 vs MDI 8.31±1.03; P < 0.001 in the
1
st
yr, and 8.28±1.22 vs 9.02±1.62; P < 0.045 in the 5
th
yr.). Total daily insulin maintained significantly
lower in the CSII group. BMI z scores increased in both groups, more in the CSII, but the difference
was not significant (0.76±1.19 vs 0.71±1.21 in 1
st
yr; P = 0.69 and 1.34±0.89 vs 0.92±1.28; P =0.15 in
5
th
yr). Two patients discontinued CSII therapy. There was no significant change in the rate of diabetic
ketoacidosis in both groups. CSII group had more severe hypoglycemic episodes at baseline than MDI
group (9.7 vs 3.7 event per 100 patient-year; P < 0.05). However, the rate of the episodes were
decreased significantly in the CSII group (5.7 vs 17.7; P < 0.05 in the 1
st
year and 4.1 vs 19.7; P <
0.05 in the 5
th
yr).
Conclusion:
CSII is a safe form of intensive insulin therapy in children and adolescents with type 1
diabetes mellitus, without significant adverse effects but with a markedly lower rate of severe
hypoglycemia and daily insulin requirements. With the available resources (financial and professional)
it could be used for all children with type 1 diabetes.
