Journal
PEDIATRIC DIABETES
Volume 12, Issue 6, Pages 556-559Publisher
WILEY
DOI: 10.1111/j.1399-5448.2010.00740.x
Keywords
BDC; CHO; clinical diabetes; CSII; devices; insulin infusion systems; insulin therapy; OR; SMBG; TDD
Categories
Funding
- Novo Nordisk
- Lilly
- Medtronic Australasia
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Introduction/Aims: Many young people experience improved glycemia with continuous subcutaneous insulin infusion (CSII) regimens; however, sustained glycemic benefit eludes a significant proportion. Our aims were to assess adherence to recommended CSII-related behaviors in a representative pediatric cohort and to identify potentially modifiable behaviors that impact on HbA1c in youth. Research Design and Methods: Data uploaded from insulin pump devices of 100 youth with type 1 diabetes were analyzed. Results: Ability to translate recommended behaviors into daily self-management varied widely in youth. Mean bolus frequency was 6.1/d; however, 69/100 entered <4 blood glucose levels (BGL)/d. HbA1c decreased by 0.2% for each additional BGL (p = 0.001) and bolus event (p < 0.001) per day. Prandial insulin omission was common and associated with significantly increased HbA1c. On average, if breakfast insulin was missed >= 4 times per fortnight, HbA1c increased 1.0% (p < 0.001). If one or more days per fortnight with >= 2 food boluses/d were recorded, then HbA1c increased 0.8% (p = 0.001). Increasing age and duration of CSII correlated with poorer adherence to recommended behaviors. Conclusions: Glycemic advantage obtained with CSII regimens is closely related to the manner in which CSII is employed. Poor adherence to integral CSII-related tasks is frequently encountered in adolescents and limits the efficacy of CSII in these youth.
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