Sustained benefits of continuous subcutaneous insulin infusion

Aim To evaluate the efficacy and safety of continuous subcutaneous insulin infusion (CSII), and its impact on glycaemic control, insulin doses and auxological parameters in children with diabetes over a 4-year period. Method A retrospective analysis of all patients treated with CSII. Data on HbA1c, height, weight, insulin doses, hypoglycaemia and diabetic ketoacidosis (DKA) were analysed. Results 67 patients, aged 1-16 years showed a mean (+/- SD) HbA1c pre-CSII of 8.2%, decreasing to 7.3% (+/- 0.8%) at 6 months (p<0.01), 7.7% (+/- 0.99) at 2 years (p<0.05), 7.4% (+/- 0.94) at 3 years (n=9, p=0.15) and 7.6% (+/- 0.97) at 4 years (n=4, p=1.0). Insulin doses reduced significantly with a trend towards reduced BMI SDS. Nine preschool children showed HbA1c reduction from 8.4% (+/- 0.94) to 7.4% (+/- 0.32, p<0.01) over 20 months with no episodes of severe hypoglycaemia or DKA. Conclusion The authors demonstrate that CSII is associated with significantly improved sustained glycaemic control, especially in preschool children with diabetes in motivated families.