Analysis of a cohort of pediatric patients treated with continuous subcutaneous insulin infusion

We analyzed a cohort of pediatric patients with type 1 diabetes mellitus treated with continuous insulin infusion (CSII), followed at the San Raffaele Hospital (Milan, Italy) in the period 2007-2014. We collected data from a questionnaire and from outpatient charts for 206 patients, whose average age was 12.93 years; 93.2% followed our protocol for starting CSII. The drop-out rate was 3.4%. Mean HbA1c was comparable to that of patients on multiple daily injections (MDI) and long-term analysis did not show any significant changes before and after CSII. The incidence of acute complications was low: 1.42 episodes/100 patients/year for severe hypoglycemia (about 50% fewer than in those using MDI), 1.11 episodes/100 patients/year for diabetic ketoacidosis. CSII patients did not gain weight and we found a significant relation between follow-up BMI and HbA1c. There was also a correlation between the use of a vertical cannula and HbA1c reduction. Most of these patients used advanced functions (bolus calculator, temporary basal rates), telemedicine and carbohydrate counting, but only carbohydrate counting was related to the improvement in HbA1c: 60.2% used continuous glucose monitoring (CGM) but here too there was no relation with reduced HbA1c; 53.4% replaced the pump at least once and 41.7% reported malfunctions (no adverse events). The distribution of insulin basal rates differed between age groups 0-6, 7-12, and 13-18 years; this confirms other reports and the advantage of CSII over MDI in children under the age of six. The average number of bolus injections was lower than expected and was not significantly related with HbA1c. CSII is safe and effective. Most studies report no significant improvement in HbA1c, but there is a lower incidence of acute complications. CSII therapy is a mandatory step towards the application of new diabetes technology (artificial pancreas) but further studies need to assess long-term cost and benefits.