Children and adolescents with type 1 diabetes can be offered an insulin pump in addition to insulin injections with a syringe or pen. However, it was previously unclear when the best time was to initiate pump therapy. This has now been investigated in a multi-centric study based on register data.
In Germany, about 32,000 children and adolescents under the age of 18 live with type 1 diabetes and are dependent on insulin substitution. It is considered proven that the continuous subcutaneous insulin infusion via the pump improves the children's metabolic control compared to insulin injections several times a day and is more comfortable, especially for smaller children. So far, however, there has been insufficient evidence on whether this should be started immediately after diagnosis or at a later stage.
For the study led by Clemes Kamrath from the Department of Paediatric Endocrinology and Diabetology at the Justus Liebig University in Giessen (in German: Justus-Liebig-Universität Gießen), data from the prospective Diabetic Medical Record or DMR register (in German: Diabetes-Patienten-Verlaufsdokumentations or DPV) were used, which includes 501 diabetes centres in Germany, Austria, Switzerland and Luxembourg. 8,332 children from 311 centres were included who had been diagnosed with type 1 diabetes between 2004 and 2014 and were between six months and fifteen years old at the time of diagnosis. An early start of insulin pump therapy (within the first six months after diagnosis) was compared with a later start (in the second or third year after diagnosis). Insulin pump therapy had to have been given for at least one year in both groups.
The results clearly showed the benefits of early pump therapy. Children in this group (n=4,004) had significantly lower mean HbA1C levels (7.9 vs. 8.0%), a 56% lower rate of hypoglycemic coma (incidence risk ratio RR 9.44) and a low rate of hospitalisation (RR 0.86) compared to the delayed group (n=4,348).
The improved glycaemic control also had a positive effect on the cardiovascular risk profile: When pump therapy was started early, the children had lower mean systolic blood pressure (117.6 mmHg vs. 118.5 mmHg) and higher HDL cholesterol (62 mg/dl vs. 60.6 mg/dl). In contrast, there were no differences between the two groups for diastolic blood pressure, LDL cholesterol, non-HDL cholesterol and triglycerides: the mean body mass index was also comparable in both groups - early insulin pump therapy was thus not associated with excessive weight gain.
For the study authors, this clearly proves that children with type 1 diabetes benefit from early initiation of insulin pump therapy immediately after diagnosis.
Source:
Clemens Kamrath et al; Early versus delayed insulin pump therapy in children with newly diagnosed type 1 diabetes: results from the multicentre, prospective diabetes follow-up DPV registry; Lancet Child Adolesc Health (2021); 5(1): 17-25; doi: 10.1016/S2352-4642(20)30339-4