Long-term outcome of insulin pump therapy in children with type 1 diabetes

The authors evaluated the long-term outcomes of insulin pump therapy in children under 18 years of age.

The increasing use of insulin pump therapy, particularly in children, has been driven by improvements in pump technology and the availability of insulin drugs. Most studies report an improvement in HbA1c (a measurement of average blood glucose levels over the past 3 months) associated with pump therapy, though some report no improvement or an initial improvement followed by a return to pre-pump levels after a short time. Reports have also suggested that insulin pumps may be associated with a reduction in severe hypoglycemia (dangerously low levels of glucose). Most studies, however, have been of very short duration. Therefore, there are few studies investigating the long-term impact of insulin pump therapy.

The current report aimed to determine the long-term impact of insulin pump therapy on diabetes outcomes over a 7 year period.

The study observed 355 patients undergoing insulin pump therapy and 355 patients who were undergoing injection therapy. HbA1c levels were 8% on average for both groups at the beginning of the study.

The average difference in HbA1c levels over the 7 years of follow-up was 0.6% between the two groups. At 3 months, HbA1c levels in the pump group were 0.6% lower than in the non-pump group. The level of improvement was lowest at 2 years, but was still significant at 0.3%. The improvement in the pump cohort increased from years 2 to 7, reaching a maximum of 1% at 6 years.

The lowest HbA1c level in the pump group was 7.6%, achieved at 3 months. At 2 years the value rose to 8.1%, and was maintained thereafter at between 7.7% and 8.1%.

After starting pump therapy, the rate of severe hypoglycemia decreased in the pump group from 14.7 to 7.2 events per 100 patient-years (the number of events that occurred during 100 years of observation of patients combined). Severe hypoglycemia increased in the non-pump cohort over the same period from 6.8 to 10.2 events per 100-patient years. The rate of hypoglycemia was 30% lower in the pump cohort than in the non-pump cohort.

The rate of hospitalization for diabetic ketoacidosis (a condition that occurs when the cells of the body do not get enough glucose for energy and the body begins to burn fat) increased in the non-pump group from 1.1 to 4.7 events per 100 patient-years. Hospitalizations in the pump group increased from 2 to 2.3 events per 100 patient-years.

The authors concluded that insulin pump therapy is associated with a significant improvement in glycemic control, which is sustained over many years.