Disappearance of severe hypoglycemias in infants and young children with continuous subcutaneous insulin infusion therapy

Background. - Conventional insulin therapy for diabetes mellitus can be inadequate for controlling glycemia in young patients in whom the risk of hypoglycemia is particularly high. Patients. - A retrospective study comparing all the children under 6 years of age treated in our department by continuous subcutaneous insulin infusion (group P, n = 10, mean age: 3.7 years) to 17 children with conventional insulin therapy (group C, mean age: 5.1 years) was conducted during a mean period of 2 years. Results. - Mean insulin doses, HbAlc, pre-prandial and daily glycemic levels, measured at 0, 3, 6, 12, 18 and 24 months, did not differ significantly between both groups. Mean HbAlc levels remained less than or equal to 8% in the two groups. There was no episode of severe hypoglycemia in group P vs ten episodes in group C (P < 0.05); this benefit was confirmed in those six children belonging to group P who had previously followed a conventional therapy: II episodes during the conventional period vs 0 episode during the pump period (P < 0.05). Nine out of ten families were very satisfied with the treatment by pump mainly because of a more comfortable life style and a reduction of parents' anxiety due to disappearance of severe hypoglycemias. The insulin pump therapy had some limits: cutaneous complications and technical ones were responsible for two keto-acidosis episodes (0.1 episode per year-patient) and a higher frequency of hospitalizations. In group C, hospitalizations were caused by severe hypoglycemias and unbalanced glycemic control. Conclusion. - Insulin pump therapy could be indicated in young diabetic children at high risk of severe hypoglycemia under conditions of a specialized medical and educational supervision and knowledge of the limits of such a treatment.