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Insulin pump therapy in children with type 1 diabetes: analysis of data from the SWEET registry

A. Szypowska, A. Schwandt, J. Svensson, S. Shalitin, R. Cardona-Hernandez, G. Forsander, F. Sundberg, C. De Beaufort, D. Maahs, C. Maffeis, SM. O'Riordan, ID. Krisane, M. Scharf, S. Castro, M. Konstantinova, B. Obermannova, K. Casteels, D....

. 2016 ; 17 Suppl 23 (-) : 38-45. [pub] 20160715

Language English Country Denmark

Document type Comparative Study, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't

Persistent link   https://www.medvik.cz/link/bmc17013665

BACKGROUND: Intensified insulin delivery using multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII) is recommended in children with type 1 diabetes (T1D) to achieve good metabolic control. OBJECTIVE: To examine the frequency of pump usage in T1D children treated in SWEET (Better control in Paediatric and Adolescent diabeteS: Working to crEate CEnTers of Reference) centers and to compare metabolic control between patients treated with CSII vs MDI. METHODS: This study included 16 570 T1D children participating in the SWEET prospective, multicenter, standardized diabetes patient registry. Datasets were aggregated over the most recent year of treatment for each patient. Data were collected until March 2016. To assess the organization of pump therapy a survey was carried out. RESULTS: Overall, 44.4% of T1D children were treated with CSII. The proportion of patients with pump usage varied between centers and decreased with increasing age compared with children treated with MDI. In a logistic regression analysis adjusting for age, gender and diabetes duration, the use of pump was associated with both: center size [odd ratio 1.51 (1.47-1.55), P < .0001) and the diabetes-related expenditure per capita [odd ratio 1.55 (1.49-1.61), P < .0001]. Linear regression analysis, adjusted for age, gender, and diabetes duration showed that both HbA1c and daily insulin dose (U/kg/d) remained decreased in children treated with CSII compared to MDI (P < .0001). CONCLUSIONS: Insulin pump therapy is offered by most Sweet centers. The differences between centers affect the frequency of use of modern technology. Despite the heterogeneity of centers, T1D children achieve relatively good metabolic control, especially those treated with insulin pumps and those of younger age.

1st Department of Pediatrics Semmelweis University Budapest Hungary

Barbara Davis Center for Childhood Diabetes University of Colorado Denver Aurora Colorado USA

Child and Young Department APDP Diabetes Lisbon Portugal

Children's University Hospital Children's Endocrinology Centre Riga Stradins University Riga Latvia

DCCP Clinique pédiatrique de Luxembourg Luxembourg Luxembourg Department of Pediatric Endocrinology UZBrussels Brussels Belgium

Department of Paediatrics Medical University of Warsaw Warsaw Poland

Department of Pediatrics and Adolescent Medicine of Medical University of Vienna Vienna Austria

Department of Pediatrics University Hospital Motol and 2nd Faculty of Medicine Charles University Prague Prague Czech Republic

Department of Pediatrics University Hospitals Leuven Leuven Belgium Department of Development and Regeneration KU Leuven Belgium

Diabetes Center Division of Endocrinology Diabetes and Metabolism 1st Department of Pediatrics Medical School National and Kapodistrian University of Athens Greece Aghia Sophia Children's Hospital Athens Greece

Division of Endocrinology and Diabetes Hospital Sant Joan de Déu Barcelona Spain

Faculty of Medicine Pediatric Endocrinology and Diabetes Ege University İzmir Turkey

Institute for Clinical Sciences Sahlgrenska Achademy University of Gothenburg Gothenburg Sweden The Queen Silvia Childrens Hospital Sahlgrenska University Hospital Gothenburg Sweden

Institute of Epidemiology and Medical Biometry ZIBMT University of Ulm Ulm Germany German Center for Diabetes Research Munich Neuherberg Germany

Medical University Clinic of Endocrinology Diabetes and Genetics Sofia University Pediatric Hospital Sofia Bulgaria

Paediatrics Diabetes and Endocrine Unit Department of Paediatrics and Child Health Cork University Hospital University College Cork Cork Ireland

Pediatric Department Copenhagen University Hospital Herlev Denmark

Pediatric Diabetes and Metabolic Disorders Unit and Regional Center for Pediatric Diabetes University Hospital University of Verona Verona Italy

Pediatric Endocrinology Hospital Nossa Senhora Das Graças Brazil

The Jesse Z and Lea Shafer Institute of Endocrinology and Diabetes National Center for Childhood Diabetes Schneider Children's Medical Center of Israel Petach Tikva Israel Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel

The Queen Silvia Childrens Hospital Sahlgrenska University Hospital Gothenburg Sweden

Unit of Pediatric Endocrinology and Diabetes Hospital Dona Estefânia Lisbon Portugal

References provided by Crossref.org

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$a BACKGROUND: Intensified insulin delivery using multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII) is recommended in children with type 1 diabetes (T1D) to achieve good metabolic control. OBJECTIVE: To examine the frequency of pump usage in T1D children treated in SWEET (Better control in Paediatric and Adolescent diabeteS: Working to crEate CEnTers of Reference) centers and to compare metabolic control between patients treated with CSII vs MDI. METHODS: This study included 16 570 T1D children participating in the SWEET prospective, multicenter, standardized diabetes patient registry. Datasets were aggregated over the most recent year of treatment for each patient. Data were collected until March 2016. To assess the organization of pump therapy a survey was carried out. RESULTS: Overall, 44.4% of T1D children were treated with CSII. The proportion of patients with pump usage varied between centers and decreased with increasing age compared with children treated with MDI. In a logistic regression analysis adjusting for age, gender and diabetes duration, the use of pump was associated with both: center size [odd ratio 1.51 (1.47-1.55), P < .0001) and the diabetes-related expenditure per capita [odd ratio 1.55 (1.49-1.61), P < .0001]. Linear regression analysis, adjusted for age, gender, and diabetes duration showed that both HbA1c and daily insulin dose (U/kg/d) remained decreased in children treated with CSII compared to MDI (P < .0001). CONCLUSIONS: Insulin pump therapy is offered by most Sweet centers. The differences between centers affect the frequency of use of modern technology. Despite the heterogeneity of centers, T1D children achieve relatively good metabolic control, especially those treated with insulin pumps and those of younger age.
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