N 4 (185) 2023. P. 48–51

CONTROL OF TYPE 1 DIABETES IN CHILDREN USING AN INSULIN PUMP: THE ЕXPERIENCE OF ODESA DOCTORS

V. I. Velychko, D. O. Lahoda, G. O. Pencho, Ya. I. Bazhora

Odesa National Medical University, Odesa, Ukraine
Municipal Non-Commercial Enterprise “Children’s Advisory and Diagnostic Center named after Academician B. Ya. Reznik” of the Odesa City Council, Odesa, Ukraine

DOI 10.32782/2226-2008-2023-4-10

Insulin pump therapy for type 1 diabetes in children is known to be associated with improved glycemic control. In 2010, a Cochrane systematic review of 23 randomized controlled trials comparing pump insulin therapy with multiple daily injections found a significant difference in glycemic control, namely glycated hemoglobin levels, in favor of pump insulin therapy. In the SWEET (Better Control of Diabetes in Children and Adolescents: Working to Create Centers of Reference) registry, 49% of children aged 6 to 11 years and 42% of children aged 12 to 18 years used insulin pumps in 2016; rates ranged from 0 to 90% among 46 diabetes centers worldwide. In addition to the actual insulin pump of a patient with type 1 diabetes, it is necessary to conduct continuous glucose monitoring. We have developed a certain algorithm for providing assistance, namely, the transfer of a child to pump insulin therapy. The results of our patients inspire us to further work. After all, glycemic control improves almost immediately and, what is very important, the quality of life of the child and his family. One of our patients, M., 11 years old, has been suffering from type 1 diabetes for 4 years. Before the insulin pump was installed, the patient had episodes of hyperglycemia following continuous glucose monitoring with peak values of approximately 12.3 mmol/L and episodes of hypoglycemia (3.2 mmol/L). After the insulin pump was installed, the patient’s maximum glycemic values were 8.4 mmol/l, and the minimum was 4.5 mmol/l. These outcomes indicate that this patient has improved T1DM control after the insulin pump and that the boy will have a better quality of life without diabetes complications. Odesa has joined the worldwide trend of installing insulin pumps for children living with type 1 diabetes. PIT improves the quality and life expectancy of patients with diabetes. Our activities within the “Type 1 Diabetes School” will continue. We invite colleagues and patients to cooperate on the diabetes issue.

Key words: children, adolescents, diabetes, diabetes control, insulin pump therapy, continuous glucose monitoring.

REFERENCES

  1. Berget C, Messer LH, Forlenza GP. A clinical overview of insulin pump therapy for the management of diabetes: past, present, and future of intensive Diabetes Spectr. 2019;32(3):194-204. doi: 10.2337/ds18-0091.
  2. Misso ML, Egberts KJ, Page M, O’Connor D, Shaw J. Continuous subcutaneous insulin infusion (CSII) versus multiple insulin injections for type 1 diabetes mellitus. Cochrane Database Syst Rev. 2010;(1):CD005103. doi: 10.1002/14651858. pub2.
  3. Pala L, Dicembrini I, Mannucci Continuous subcutaneous insulin infusion vs modern multiple injection regimens in type 1 diabetes: an updated meta-analysis of randomized clinical trials. Acta Diabetol. 2019;56(9):973-80. doi: 10.1007/ s00592-019-01326-5.
  4. Pihoker C, Badaru A, Anderson A, Morgan T, Dolan L, Dabelea D, Imperatore G, et Insulin regimens and clinical outcomes in a type 1 diabetes cohort: the SEARCH for Diabetes in Youth study. Diabetes Care. 2013;36(1):27-33. doi: 10.2337/dc12-0720.
  5. Karges B, Schwandt A, Heidtmann B, Kordonouri O, Binder E, Schierloh U, et al. Association of insulin pump therapy vs insulin injection therapy with severe hypoglycemia, ketoacidosis, and glycemic control among children, adolescents, and young adults with type 1 JAMA. 2017;318:1358-66. doi: 10.1001/jama.2017.13994.
  6. Szypowska A, Schwandt A, Svensson J, Shalitin S, Cardona-Hernandez R, Forsander G, et al. Insulin pump therapy in children with type 1 diabetes: analysis of data from the SWEET registry. Pediatr Diabetes. 2016;17 Suppl 23:38-45. doi: 1111/pedi.12416.
  7. Foster NC, Beck RW, Miller KM, Clements MA, Rickels MR, DiMeglio LA, et State of type 1 diabetes management and outcomes from the T1D exchange in 2016–2018. Diabetes Technol Ther. 2019;21(2):66-72. doi: 10.1089/dia.2018.0384.
  8. Alonso GT, Corathers S, Shah A, Clements M, Kamboj M, Sonabend R, et al. Establishment of the T1D Exchange Quality Improvement Collaborative (T1DX-QI). Clin Diabetes. 2020;38(2):141–151. doi: 10.2337/cd19-0032.
  9. How to improve [Internet]. 2023 [citen 2023 Nov 20]. Available from: http://www.ihi.org:80/resources/Pages/HowtoImprove/aspx
  10. Leis JA, Shojania KG. A primer on PDSA: executing plan-do-study-act cycles in practice, not just in name. BMJ Qual Saf. 2017;26(7):572-77. doi: 1136/bmjqs-2016-006245.
  11. The R project for statistical computing. The R Foundation [Internet]. [Citen 2023 Nov 20]. Available from: https://www.r- org. Accessed 1 July 2020
  12. Messer LH, Tanenbaum ML, Cook PF, Wong JJ, Hanes SJ, Driscoll KA, et Cost, hassle, and on-body experience: barriers to diabetes device use in adolescents and potential intervention targets. Diabetes Technol Ther. 2020;22(10):760-67. doi: 10.1089/dia.2019.0509.
  13. Tanenbaum ML, Hanes SJ, Miller KM, Naranjo D, Bensen R, Hood Diabetes device use in adults with type 1 diabetes: barriers to uptake and potential intervention targets. Diabetes Care. 2017;40(2):181-7. doi: 10.2337/dc16-1536.
  14. Wong JC, Boyle C, DiMeglio LA, Mastrandrea LD,Abel KL, Cengiz E, et Evaluation of pump discontinuation and associated factors in the T1D Exchange clinic registry. J Diabetes Sci Technol. 2017;11(2):224-32. doi: 10.1177/1932296816663963.
  15. Marks BE, Wolfsdorf JI, Waldman G, Stafford DE, Garvey KC. Pediatric endocrinology trainees’ education and knowledge about insulin pumps and continuous glucose monitors. Diabetes Technol Ther. 2019;21(3):105-9. doi: 10.1089/dia.2018.0331.
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