Continuous subcutaneous insulin infusion (CSII) effectively optimizes glycemic control in very young patients with type 1 diabetes, according to a report published in the December issue of Pediatrics. This treatment may be superior to multiple daily injections in lowering the risk of severe hypoglycemia.

Dr. Stuart A. Weinzimer and colleagues from Yale University School of Medicine, New Haven, Connecticut, note that "pump therapy has been shown to be a safe and effective alternative to multiple daily injections in adults and older pediatric patients." Its use in very young children, however, has been limited.

To investigate further, the researchers examined the safety and efficacy of CSII in 65 children, ranging in age from about 1 to 7 years, with type 1 diabetes. The team compared glycosylated hemoglobin (HbA1c), severe hypoglycemia, and ketoacidosis (DKA) in the year before CSII with corresponding values during pump therapy.

A mean decrease in HbA1c from 7.4% to 7.0% was seen after 12 months of CSII therapy. Improvement continued even after 4 years on CSII. Severe hypoglycemia rates decreased in the group as a whole by 53%, from 78 events per 100 patient-years to 34 per 100 patient-years.

No episodes of DKA were observed in the year before CSII therapy. However, in the postpump period, there were four DKA episodes.

The researchers also note that this study is the first to show that the pump use is successful in children who have caregivers such as nannies. Children who received daytime care from paid caregivers experienced significant reductions in HbA1c (from 7.5% before pump use, to 7.1% thereafter).

Source: Diabetes In Control.com: Pediatrics 2004;114:1601-1605.