[Remission of severe hypoglycemic incidents in young diabetic children treated with subcutaneous infusion]

Arch Pediatr. 1996 Oct;3(10):969-76. doi: 10.1016/0929-693x(96)81717-9.
[Article in French]

Abstract

Background: Conventional insulin therapy for diabetes mellitus can be inadequate for controlling glycemia in young patients in whom the risk of hypoglycemia is particularly high.

Patients: A retrospective study comparing all the children under 6 years of age treated in our department by continuous subcutaneous insulin infusion (group P, n = 10, mean age: 3.7 years) to 17 children with conventional insulin therapy (group C, mean age: 5.1 years) was conducted during a mean period of 2 years.

Results: Mean insulin doses, HbAlc, pre-prandial and daily glycemic levels, measured at 0, 3, 6, 12, 18 and 24 months, did not differ significantly between both groups. Mean HbAlc levels remained < or = 8% in the two groups. There was no episode of severe hypoglycemia in group P vs ten episodes in group C (P < 0.05); this benefit was confirmed in those six children belonging to group P who had previously followed a conventional therapy: 11 episodes during the conventional period vs 0 episode during the pump period (P < 0.05). Nine out of ten families were very satisfied with the treatment by pump mainly because of a more comfortable life style and a reduction of parents' anxiety due to disappearance of severe hypoglycemias. The insulin pump therapy had some limits: cutaneous complications and technical ones were responsible for two keto-acidosis episodes (0.1 episode per year-patient) and a higher frequency of hospitalizations. In group C, hospitalizations were caused by severe hypoglycemias and unbalanced glycemic control.

Conclusions: Insulin pump therapy could be indicated in young diabetic children at high risk of severe hypoglycemia under conditions of a specialized medical and educational supervision and knowledge of the limits of such a treatment.

MeSH terms

  • Age Factors
  • Child, Preschool
  • Diabetes Mellitus, Type 1 / therapy*
  • Diabetic Ketoacidosis / epidemiology
  • Diabetic Ketoacidosis / etiology
  • Female
  • Glycated Hemoglobin A / analysis
  • Hospitalization / statistics & numerical data
  • Humans
  • Hypoglycemia / epidemiology
  • Hypoglycemia / etiology*
  • Infant
  • Infant, Newborn
  • Infusion Pumps, Implantable
  • Insulin Infusion Systems / adverse effects*
  • Male
  • Retrospective Studies

Substances

  • Glycated Hemoglobin A