In Pediatric Type 1 Diabetes, Continuous SQ Insulin Infusions Do Not Lower HbA1c More Than MDI

A female diabetes health care specialist with a young diabetes patient, testing his blood sugar levels.
Study authors conducted a retrospective cohort study to compare CSII and MDI treatments on metabolic control, body mass index, and prevalence of severe hypoglycemia in children.

Pediatric patients with type 1 diabetes receiving continuous subcutaneous insulin infusions (CSII) or multiple daily injections (MDI) both experienced a decrease in hemoglobin HbA1c (HbA1c) level with no significant reduction in HbA1c from treatment with CSII, according to research published in Pediatric Diabetes.

This retrospective cohort study compared CSII and MDI treatments on metabolic control, body mass index (BMI), and prevalence of severe hypoglycemia in children up to 17 years of age with type 1 diabetes using real-world data from the Swedish National Diabetes Register (SWEDIABKIDS).

Investigators split patients into a cross-sectional cohort and a longitudinal cohort using data from the SWEDIABKIDS. The longitudinal cohort included patients up to 15 years of age who have had type 1 diabetes for more than 6 months, have stayed on the same insulin delivery method, and have at least 1 HbA1c value on record. The final cohort consisted of 3928 unique patients.

Cross-sectional data results indicated an increase in the use of CSII in both boys (35% to 56%; P <.001) and girls (41% to 60%; P <.001) throughout the duration of the study. Overall, patients using CSII in both cohorts were typically younger than patients using MDI. Patients using CSII from the cross-sectional cohort also tended to have diabetes for longer than patients using MDI.

When analyzing metabolic control, investigators observed an HbA1c decrease of 0.5%, though there was no statistically significant difference in HbA1c observed in CSII compared with MDI.

In patients with an HbA1c of more than 8.7%, study authors found that age did not affect results between delivery methods. Patients using CSII had lower HbA1c (9.2%) compared with patients using MDI (9.4%). Boys between the ages of 13 and 17 who used CSII had a higher mean HbA1c level than boys of the same age who used MDI (7.7% vs 7.5%, respectively; P <.001). For both cohorts, significant changes in BMI and severe hypoglycemia were not observed between treatment delivery methods.

From the longitudinal cohort, an increase in HbA1c level by age existed for both MDI and CSII groups. A higher percentage of girls (54%) switched their treatment delivery method, usually from MDI to CSII. At baseline, girls were 30% more likely to be using CSII (odds ratio, 1.30; 95% CI, 1.16-1.45; P =.001) than boys, falling to 22% by the end of the study (odds ratio, 1.22; 95% CI, 1.10-1.36; P = .001).

Patients using CSII had a shorter diabetes duration and an average HbA1c reduction of 0.6%, while these values remained constant for patients using MDI. Overall, CSII users did not show a significant decrease in HbA1c when compared with MDI users.

Study limitations include lack of data on indication for CSII initiation.


Fureman AL, Lilja M, Lind T, et al. Comparing continuous subcutaneous insulin infusion and multiple daily injections in children with type 1 diabetes in Sweden from 2011 to 2016 – a longitudinal study from the Swedish National Quality Register (SWEDIABKIDS). Pediatr Diabetes. Published online May 18, 2021. doi:10.1111/pedi.13217