Journal
DIABETOLOGIA
Volume 59, Issue 1, Pages 87-91Publisher
SPRINGER
DOI: 10.1007/s00125-015-3790-6
Keywords
Clinical outcomes; Continuous subcutaneous insulin infusion; DPV; Insulin pumps; National Paediatric Diabetes Audit; T1D Exchange clinic registry; Treatment modalities; Type 1 diabetes
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Funding
- Leona M. and Harry B. Helmsley Charitable Trust
- German BMBF Competence Network Diabetes Mellitus [FKZ 01GI1106]
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Aims/hypothesis While the use of insulin pumps in paediatrics has expanded dramatically, there is still considerable variability among countries in the use of pump technology. The present study sought to describe differences in metabolic control and pump use in young people with type 1 diabetes using data collected in three multicentre registries. Methods Data for the years 2011 and 2012 from 54,410 children and adolescents were collected from the Prospective Diabetes Follow-up Registry (DPV; n = 26,198), T1D Exchange (T1DX; n = 13,755) and the National Paediatric Diabetes Audit (NPDA; n = 14,457). The modality of insulin delivery, based on age, sex and ethnic minority status, and the impact of pump use on HbA(1c) levels were compared. Results The overall mean HbA(1c) level was higher in the NPDA (8.9 +/- 1.6% [74 +/- 17.5 mmol/mol]) than in the DPV (8.0 +/- 1.6% [64 +/- 7.0 mmol/mol], p < 0.001) and T1DX (8.3 +/- 1.4% [68 +/- 15.4 mmol/mol], p < 0.001). Conversely, pump use was much lower in the NPDA (14%) than in the DPV (41%, p < 0.001) and T1DX (47%, p < 0.001). In a pooled analysis, pump use was associated with a lower mean HbA(1c) (pump: 8.0 +/- 1.2% [64 +/- 13.3 mmol/mol] vs injection: 8.5 +/- 1.7% [69 +/- 18.7 mmol/mol], p < 0.001). In all three registries, those with an ethnic minority status were less likely to be treated with a pump (p < 0.001) and boys were treated with a pump less often compared with girls (p < 0.001). Conclusions/interpretation Despite similar clinical characteristics and proportion of minority participants, substantial differences in metabolic control exist across the three large transatlantic registries of paediatric patients with type 1 diabetes, which appears to be due in part to the frequency of insulin pump therapy.
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