Insulin Pumps Improve Blood Glucose Control in Children with Type 1 Diabetes

Data from 3 diabetes registries from the United States, Germany and Austria, and England and Wales suggest that insulin pumps can help children and adolescents with type 1 diabetes effectively improve their blood glucose control.

The study, conducted by Jennifer Sherr, MD, PhD, from the Children’s Diabetes Program at Yale School of Medicine in New Haven, Connecticut, and colleagues, was recently published in Diabetologia.

“Pump use has allowed our children and adolescents with type 1 diabetes a better chance at achieving glycemic control,” Dr Sherr told Endocrinology Advisor. “As documented in a number of small pediatric trials of pump therapy, a reduction in HbA1c has been seen. Our cross-sectional data of 3 large trans-Atlantic registries confirm these findings, demonstrating that pump use, in a pooled analysis, led to a 0.5% reduction in HbA1c.”

Insulin pumps have been a common treatment option for blood glucose management since the beginning of this century, according to background information in the study. The devices keep blood glucose levels within acceptable parameters, but without insulin pumps children and adolescents have to use multiple daily insulin injections.

In 2007, a joint consensus statement from several pediatric endocrine and diabetes specialist societies recommended that insulin pumps should be considered for use in children and adolescents if they had suboptimal diabetes control, severe fluctuations in blood glucose levels, and their insulin regimen affected lifestyle.

“Pump therapy has the ability to allow achievement of targeted glycemic control while not increasing burden for our youth with type 1 diabetes,” said Dr Sherr. “It allows for more fine-tuned insulin dose titration and can prevent stacking of insulin boluses through the insulin on board feature present in pumps.”

The researchers compared data from the German/Austrian Prospective Diabetes Follow-up Registry (DPV), the United States T1D Exchange (T1DX), and the English/Welsh National Paediatric Diabetes Audit (NPDA).

The data from the DPV cohort was a combined analysis of individuals from Germany and Austria, containing 26 198 participants from 209 sites. The T1DX cohort included 13 755 participants from 57 pediatric registry sites who enrolled between September 2010 and August 2012. The NPDA cohort included 14 457 participants, collected between April 2011 and March 2012, from England and Wales for a combined analysis.

The mean HbA1c level was worse in the NPDA cohort than in the DPV and T1DX cohorts (8.9% vs 8.0% and 8.3%, respectively; P<.001 for both). Insulin pump use was also lower in the NPDA cohort compared with the DPV and T1DX cohorts (14% vs 41% and 47%, respectively; P<.001 for both). Among all 3 cohorts, insulin pump use was linked to a mean HbA1c level of 8.0%, compared with 8.5% for insulin injection (P<.001).

“As data from 3 trans-Atlantic registries have identified the beneficial glycemic effect of insulin pump use with mean HbA1c being 0.5% lower than what is achieved by those on injection therapy, application of this technology for all youth with [type 1 diabetes] should be a focus of care,” said Dr Sherr. 

“Clinicians should investigate their prescribing patterns and be aware that pump use can be applied regardless of patient age, gender, or ethnic background. Patients should advocate for themselves in order to assure they are being considered for this treatment modality.”

The results showed that across all 3 registries, only 22% of participants with an ethnic minority status used the insulin pump, compared with 34% of non-minorities. The researchers also found that 30% of boys were treated with a pump, compared with 34% of girls.

The authors noted that rates of registries differed by age at each registry. Insulin pump use in the NPDA registry was only one-third the size of the other 2 cohorts, which could be a result of the United Kingdom’s National Health Institute for Health and Care Excellence (NICE) recommendations to limit insulin pump use for children and adolescents. 

Of the 3 registries, the overall HbA1c levels were highest in the NPDA. The NPDA cohort also had the greatest difference in HbA1c levels between injection treatments and insulin pump therapy, while the DPV had the smallest difference in treatments.

Dr Sherr stated that additional research should be conducted to assess the factors that would determine who is eligible for insulin pump therapy, and to find a way to assure equal access to insulin pump treatment regardless of age, ethic status, or gender.

“Additionally, exploration of health policy allowing for coverage of such medical devices is warranted to assure our youth are afforded the best care possible,” she said. “This will become critically important, as the next revolution of diabetes care is a mechanical solution, specifically the artificial pancreas, which relies on insulin pump use for system performance.”

Reference

Sherr JL, Hermann JM, Campbell F, et al. Use of insulin pump therapy in children and adolescents with type 1 diabetes and its impact on metabolic control: comparison of results from three large, transatlantic paediatric registries. Diabetologia. 2015;doi:10.1007/s00125-015-3790-6.