Failure of glycated hemoglobin drop after continuous subcutaneous insulin infusion initiation may indicate patients who discontinue: a 4-year follow-up study in children and adolescents with type 1 diabetes

Continuous subcutaneous insulin infusion (CSII) is effective and safe in children and adults with type 1 diabetes. Notwithstanding, some patients decide to discontinue using CSII. We evaluated the discontinuation rate, and its related factors, in a large group of children and adolescents with type 1 diabetes using CSII in Italy. Data on all patients with type 1 diabetes younger than 18 years were collected by 28 Pediatric Diabetologic referral Centers located throughout Italy. The primary endpoint was to measure the discontinuation rate using CSII. Among the study population (n = 6,644), 985 (14.8%) were using CSII. Sixty patients discontinued using CSII, representing the 6.1%. The discontinuation rate significantly increased (P = 0.002) with age: 0-6 years, 1/84 (1.2%), 7-11 years, 8/262 (3.1%), 12-18 years, 51/579 (8.8%). The average time to discontinuation was 1.8 +/- 1.4 years. The average age of patients who discontinued using CSII was higher than in patients still on CSII (12.1 +/- 3.2 vs. 10.3 +/- 3.8, P = 0.0001), while their diabetes duration was significantly shorter (8.6 +/- 2.7 vs. 10.2 +/- 3.7, P = 0.0001). HbA1c decreased only in patients still on CSII (8.7 +/- 1.3% vs. 7.8 +/- 1.3%, P = 0.02), but not in patients who discontinued using CSII (8.5 +/- 1.6% vs. 8.2 +/- 1.3%, P = 0.213). HbA1c might be one important indicator helpful to identify patients at higher risk discontinuing using CSII.