scholarly journals Long-term glycemic control and factors, associated with response to pump insulin therapy in children

2021 ◽  
Vol 24 (2) ◽  
pp. 122-132
Author(s):  
D. N. Laptev ◽  
A. O. Emelyanov ◽  
E D Medvedeva ◽  
S. V. Pereverzeva ◽  
V. A. Peterkova
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Insulin Therapy ◽  
Response To Treatment ◽  
Significant Heterogeneity ◽  
Target Level ◽  
Pump Therapy ◽  
Factors Associated ◽  
Number Of Patients

Background: In recent years, pump-based insulin therapy, also known as continuous subcutaneous insulin infusion (CSII), has become a common treatment for children with type 1 diabetes mellitus (T1DM). Despite the fact that, in general, children with type 1 diabetes achieve the best glycemic control indices during pump therapy, while there is a significant heterogeneity of metabolic outcomes among individual patients, many children with CSII do not reach the target level of HbA1c.Objective: To assess the level of glycemic control and factors associated by withdrawal of use, the response to treatment with prolonged use of CSII in children with type 1 diabetes.Materials and methods: The study included 458 children aged 1 to 18 years, treated to pump therapy at least 3 years before the study, the presence of the analyzed data in the register.Results: The level of HbA1c decreased by -0.7% compared with the primary endpoint, which was accompanied by an increase in the number of patients who reached the target level of HbA1c (<7.5%) from 17% to 36%. The best response was observed for patients under 6 years of age with HbA1c over 9% for pump insulin therapy, as well as in patients who regularly use additional bolus and basal functions and CGM. The main reason for stopping the use of the insulin pump is the inconvenience of using and wearing — 47.7%. Risk factors for pump abandonment: later age of start treatment on CSII and frequent episodes of severe hypoglycemia.Conclusion: According to the results of the study, it was shown that pump therapy is an effective method of insulin therapy, which allows to achieve a lower level of HbA1c compared to the initial values.

Factors associated with glycemic control in adult type 1 diabetes patients treated with insulin pump therapy

Endocrine ◽  
2014 ◽  
Vol 48 (1) ◽  
pp. 164-169 ◽  
Author(s):  
Bartłomiej Matejko ◽  
Jan Skupien ◽  
Sandra Mrozińska ◽  
Małgorzata Grzanka ◽  
Katarzyna Cyganek ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Insulin Pump ◽  
Insulin Pump Therapy ◽  
Pump Therapy ◽  
Adult Type ◽  
Factors Associated ◽  
Diabetes Patients

scholarly journals Remote monitoring and treatment of children and adolescents with type 1 diabetes

2020 ◽  
Vol 66 (4) ◽  
pp. 50-60
Author(s):  
Dmitry N. Laptev ◽  
Andrey O. Emelyanov ◽  
Yulia G. Samoilova ◽  
Elena B. Khramova ◽  
Elena E. Petriaikina ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Insulin Therapy ◽  
Children And Adolescents ◽  
Remote Monitoring ◽  
Insulin Pump ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Number Of Patients

RATIONALE: Continuous subcutaneous insulin infusion (CSII) is an effective method for optimizing glycemic control in children with type 1 diabetes mellitus (DM1). However, the use of CSII does not always result in adequate glycemic control. Telehealth can be applied as one of the methods to improve the effectiveness of treatment.AIMS: To evaluate the use of remote medical support of children and adolescents with DM1 and its influence on glycemic control, quality of life, and incidence of acute complications of DM1.MATERIALS AND METHODS: We conducted a 24-week multi-institutional prospective open-label controlled clinical trial. 180 children and adolescents were included in this study and divided into the following categories: 1) age 8–18 years; 2) DM1 at least 1 year; 3) pump insulin therapy Medtronic Paradigm (Medtronic MiniMed, USA) at least 6 months; 4) self-monitoring of glycemia at least 4 times a day and replacement of the insulin pump infusion system at least once every 3 days; 5) inadequate glycemic control of DM1: the level of glycated hemoglobin (HbA1c) 7.5% or higher. Patients were assigned to a remote consultation group (RC; n=100) or a traditional control group (TC; n=80). All patients were trained on the basic principles of DM1 and CSII, and we measured initial HbA1c, then after 12 and 24 weeks, also registered and analyzed glycemic indicators and daily doses of insulin, evaluated and corrected the treatment. Patients or their parents in the RC group sent pump data via the Internet to the pump insulin therapy center at least once every 2 weeks at home and received treatment recommendations in response.RESULTS: The total number of patients included in the study in all institutions was 180 children at 8–18 years. Patients in both groups did not differ in age, gender, duration of DM1 and CSII, and HbA1c level. The total amount of remote consultations for all institutions was 949. The decrease in the level of HbA1c by the end of the study against the initial one was statistically significantly greater in the RC group: 1.17% compared to 0.59% in the TC group (p<0.05). The proportion of patients who reached the target level of HbA1c (<7.5%) was significantly higher in the RC group (32%) compared to the TC group (12.5%, p<0.05). During the study, the incidence of DKA and severe hypoglycemia in the RC group was statistically significantly lower.CONCLUSIONS: Remote monitoring in children with DM1 resulted in significant improvements in glycemic control (HbA1c, glycemic variability, and hypoglycemic frequency). The accumulation of evidence on the effectiveness and safety of telehealth in DM should contribute to implementing this approach in practical health care.

724-P: Factors Associated with Glycemic Control in People with Type 1 Diabetes (PWT1D) Switched to Once Daily (QD) Insulin Glargine (Gla) 300 U/mL (Gla-300): The European REALI Pooled Database

Diabetes ◽  
2021 ◽  
Vol 70 (Supplement 1) ◽  
pp. 724-P
Author(s):  
DIRK MÜLLER-WIELAND ◽  
PIERRE GOURDY ◽  
RICCARDO C. BONADONNA ◽  
NICK FREEMANTLE ◽  
GREGORY BIGOT ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Insulin Glargine ◽  
Once Daily ◽  
Factors Associated

scholarly journals Use of a do-it-yourself artificial pancreas system is associated with better glucose management and higher quality of life among adults with type 1 diabetes

2020 ◽  
Vol 11 ◽  
pp. 204201882095014
Author(s):  
Zekai Wu ◽  
Sihui Luo ◽  
Xueying Zheng ◽  
Yan Bi ◽  
Wen Xu ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Artificial Pancreas ◽  
Pump Therapy ◽  
Quality Of Life Scale ◽  
Do It Yourself ◽  
Glucose Management

Background: Previous studies show that the use of do-it-yourself artificial pancreas system (DIYAPS) may be associated with better glycemic control characterized by improved estimated hemoglobin A1c (eHbA1c) and time in range among adults with type 1 diabetes (T1D). However, few studies have demonstrated the changes in laboratory-measured HbA1c, which is a more accepted index for glycemic control, after using a DIYAPS. Methods: This is a retrospective before-after study approaching patients who reported self-use of AndroidAPS. The main inclusion criteria included: T1D; aged ⩾18 years; having complete record of ⩾3 months of continuous AndroidAPS use; with laboratory-measured HbA1c and quality of life scale data before and after 3 months of AndroidAPS use; and not pregnant. The primary outcome was the change in HbA1c between baseline and 3 months after initiation of AndroidAPS use. Results: Overall, 15 patients (10 females) were included; the median age was 32.2 years (range: 19.2–69.4), median diabetes duration was 9.7 years (range: 1.8–23.7) and median baseline HbA1c was 7.3% (range: 6.4–10.1). The 3 months of AndroidAPS use was associated with substantial reductions in HbA1c [6.79% (SD: 1.29) versus 7.63% (SD: 1.06), p = 0.002] and glycemic variability when compared with sensor-augmented pump therapy. A lower level of fear of hypoglycemia [22.13 points (SD: 6.87) versus 26.27 points (SD: 5.82), p = 0.010] was also observed after using AndroidAPS. Conclusions: The 3 months of AndroidAPS use was associated with significant improvements in glucose management and quality of life among adults with T1D.

PARENTAL PERCEPTION AND FACTORS ASSOCIATED WITH GLYCEMIC CONTROL IN PEDIATRIC PATIENTS WITH TYPE 1 DIABETES

2002 ◽  
Vol 8 (2) ◽  
pp. 105-108 ◽  
Author(s):  
J. Paul Frindik, MD, FACE ◽  
Jane P. Williams, PhD ◽  
Rae Lynn Johnson, RN, CDE ◽  
Roscoe A. Dykman, PhD
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Pediatric Patients ◽  
Parental Perception ◽  
Factors Associated

Initiation of insulin pump therapy in children at diagnosis of type 1 diabetes resulted in improved long-term glycemic control

2016 ◽  
Vol 18 (1) ◽  
pp. 26-32 ◽  
Author(s):  
Eunice G. Lang ◽  
Bruce R. King ◽  
Malcolm N. Miller ◽  
Sandra V. Dunn ◽  
Darrell A. Price ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Insulin Pump ◽  
Insulin Pump Therapy ◽  
Pump Therapy

Contrasting Challenges of Insulin Pump Therapy in a Toddler and Adolescent With Type 1 Diabetes

2005 ◽  
Vol 31 (4) ◽  
pp. 584-590 ◽  
Author(s):  
Elizabeth A. Doyle ◽  
Amy T. Steffen ◽  
William V. Tamborlane
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Insulin Pump ◽  
Insulin Pump Therapy ◽  
Pump Therapy ◽  
Diabetes Clinic ◽  
Physically Active ◽  
Parental Assistance ◽  
Life Improvement

Purpose To describe the challenges and outcomes of continuous subcutaneous insulin infusion (CSII) pump therapy in a toddler and adolescent with type 1 diabetes. Insight into patient-family aspects motivating pump use is provided. Methods Two cases treated at the Pediatric Diabetes Clinic at Yale University. Results Upon parental request, CSII was initiated to improve glycemic control in a 4-year-old boy (case 1) with unpredictable food intake. During 68 months of CSII therapy, hemoglobin A1C levels averaged 6.3% ± 0.6%. Severe hypoglycemic episodes ceased 36 months ago, and occasional postprandial hyperglycemia during early school years was corrected with school nurses’ reminders about premeal insulin bolus doses. Currently 9.5 years old, he independently manages all his insulin injections with parental assistance only to change the catheter site. Case 2 is a girl who was nearly 12 years of age when diagnosed with type 1 diabetes. Initially managed with daily injections, hypoglycemic episodes were interfering with her physically active lifestyle. At age 13 years, she elected CSII therapy, and glycemic control improved. Temporarily erratic in the immediate period pre- and postmenarche, metabolic control has since stabilized. At 15 years old, she successfully manages her diabetes independently. Conclusions To optimize glycemic control, CSII can be initiated and used effectively, both in children of all ages and in adolescents with type 1 diabetes. CSII may be ideal therapy for toddlers, with no apparent lower age boundary for initiating CSII; however, the parenting challenges and requirements for supportive education differ between toddlers and adolescents. When disease and pump management are appropriately individualized, CSII therapy can help children with diabetes achieve and sustain glycemic control. Lifestyle flexibility, quality-of-life improvement, and independence can thus begin early in childhood and be maintained throughout young adulthood.

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