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Insulin pumps improve control and reduce complications in children with type 1 diabetes

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f5154 (Published 19 August 2013) Cite this as: BMJ 2013;347:f5154
  1. Zosia Kmietowicz
  1. 1BMJ

Children with type 1 diabetes who use an insulin pump rather than injections have better long term control of their disease and experience fewer episodes of severe hypoglycaemia and diabetic ketoacidosis, a study has found.

Previous studies have shown that insulin pumps improve HbA1c, although some found this was only temporary. Reductions in severe hypoglycaemia have also been demonstrated.

Few of these studies have lasted more than a few years, so to assess the impact of insulin pumps in children longer term, researchers from the Princess Margaret Hospital for Children in Perth, Australia, set up the population based study for a seven year period.

They recruited 345 children on insulin pump therapy who were matched to controls using injections. The children had a mean age of 11.4 years at the start of the study, had had diabetes for four years, and were followed up for a mean of 3.5 years.

The findings, reported in Diabetologia, showed that at the start of the study there was no difference between children on a pump and those using injections in terms of HbA1c (8%, 63.9 mmol/mol).1 Over the following seven years the mean difference in HbA1c between the pump and non-pump groups was 0.6% (6.6 mmol/mol). This improved HbA1c remained significant until seven years of follow-up (at which point the numbers in the study were too small to analyse the results with statistical confidence). The maximum difference was 1% difference at six years: 7.6 % in the pump group and 8.6 % in the non-pump group.

During the study the rate episodes of severe hypoglycaemia halved among children using an insulin pump from 14.7 events per 100 patient years to 7.2 (P=0.001). However, episodes of severe hypoglycaemia increased in children treated with injections (from 6.8 to 10.2 events per 100 patient years).

Before the study both groups of children had the same rate of hospital admissions for diabetic ketoacidosis but during the follow-up hospitalisations for this complication among pump users was half that of children using injections (2.3 per 100 patient years compared with 4.7, P<0.01).

Through the course of the study 38 of the 345 children on pump therapy gave up the pump mainly because they became tired of the extra attention needed to manage it and because of concerns about the physical sight of the pump.

Elizabeth Davis, one of the study’s authors, concluded, “Children and adolescents with poor control had the greatest reduction in HbA1c with insulin pump therapy. . . Although this is not a randomised trial, it is ‘real life’ experience in a large population based sample over a prolonged time period and as such provides important information.”

Commenting on the study Bridget Turner, director of policy and care improvement at charity Diabetes UK, said that the study provided further evidence of the good glycaemic control achievable with insulin pumps, which in the long term can help reduce the risk of serious complications.

She added, “This is why it is a real concern that the UK is lagging behind comparable countries in terms of insulin pump usage. We want the NHS to do more to ensure there are enough healthcare professionals who are qualified to support children and adults with type 1 diabetes to use a pump effectively, so that everyone who wants to use one is able to do so. This could make a real difference to ensuring that everyone with diabetes has the best possible chance of a long and healthy life.”

Notes

Cite this as: BMJ 2013;347:f5154

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