| Abstract: |
This article presents a consensus statement on the use of insulin pump therapy in the pediatric age group, implemented primarily to avoid recurrent episodes of hypoglycemia in patients seeking to achieve near-normal blood glucose ranges. Continuous subcutaneous insulin infusion (CSII) is used to closely simulate the normal pattern of insulin secretion and offers more flexibility and more precise insulin delivery than multiple daily injections (MDI). The consensus panel was convened to clear up controversy as to whether CSII has advantages over MDI in terms of reduction in blood glucose levels, occurrence of severe hypoglycemic events, episodes of diabetic ketoacidosis (DKA), and frequency of hospitalizations in young patients. In addition, physicians need guidelines for choosing patients for whom CSII therapy might be appropriate. Recommendations are provided in the areas of glycosylated hemoglobin (A1C) levels, severe hypoglycemia, blood glucose variability, physical activity and exercise, weight gain, metabolic deterioration, infusion site reactions, psychosocial issues, pump features, selecting an insulin pump, catheter features, calculating and timing the prandial (bolus) insulin requirement, monitoring patients on CSII, cost-effectiveness, and terminating CSII. The authors conclude that CSII use in children and adolescents may be associated with improved glycemic control and improved quality of life and poses no greater, and possibly less, risk than MDI. Minimizing the risks of CSII entails the same interventions that promote safety in all patients with type 1 diabetes, including proper education, frequent blood glucose monitoring, attention to diet and exercise, and the ongoing of communication with a diabetes team. 1 table. 95 references. |