Feasibility and safety of insulin pump therapy in children aged 2 to 7 years with type 1 diabetes: a retrospective study

BACKGROUND AND OBJECTIVES. Although insulin pump therapy has been successful in adults, adolescents and school children, its use has been limited in young children. The purpose of this study was to evaluate the glycemic control, safety and efficacy of continuous subcutaneous insulin infusion via pump in young children (2-7 years old) with type 1 diabetes who were transitioned from twice-a-day insulin injection ( neutral protamine Hagedorn/ Lente + Humalog/Novalog) to insulin pump therapy. Hemoglobin A1c, BMI, average fasting blood glucose, episodes of severe hypoglycemia, episodes of diabetic ketoacidosis, episodes of lipohypertrophy, blood glucose variability, and number of sick day calls were compared before and after insulin pump therapy. METHODS. Data were collected retrospectively by chart review over a 2-year period during quarterly diabetes clinic visits from 33 patients who were managed on neutral protamine Hagedorn/ Lente + Humalog/Novolog twice-a-day injections for at least 1 year prior to transitioning to insulin pump therapy. RESULTS. There was a significant improvement in the average hemoglobin A1c after continuous subcutaneous insulin infusion therapy. The average fasting blood sugar was lower in the continuous subcutaneous insulin infusion group. Severe episodes of hypoglycemia and episodes of lipohypertrophy were significantly higher before insulin pump therapy initiation. There were significantly fewer sick day calls after continuous subcutaneous insulin infusion. Blood sugar variability improved significantly after insulin pump therapy. There was no significant difference in BMI or amount of carbohydrate consumed. None of the patients experienced diabetic ketoacidosis requiring emergency treatment before or after insulin pump therapy. CONCLUSIONS. Continous subcutaneous insulin infusion therapy in young children with type 1 diabetes is a safe, effective and superior alternative to a twice-a-day insulin regimen.