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Use of Insulin Pump Therapy at Night Only for Pre-Teen Children with Type 1 Diabetes
Highlights from The 59th Scientific Sessions of the American Diabetes Association in San Diego

On Saturday, June 19, 1999, Francine Kaufman, MD presented Use of Insulin Pump Therapy at Night Only for Pre-Teen Children with Type 1 Diabetes. This study was the work of Francine Kaufman, Mary Halvorson, and Christina Kim from Los Angeles, California. It looked at whether insulin pump therapy overnight may be a viable option for children who are not developmentally capable of managing the pump during the day when there is no adult supervision. The team studied ten children ages 7-10 years who had a mean hemoglobin A1c of 7.6%. After a two week stabilization period, the children then followed a treatment plan of 3 shots per day or the insulin pump overnight for two weeks each. The order of the therapy was randomly assigned. The 3 shots of insulin per day involved NPH and Humalog insulins. The pump was used from dinner onward until breakfast, with 40% of the 24 hour dose of insulin given by pump, and 60% by injections of morning NPH and Humalog. In both groups extra Humalog was used to correct high blood sugars. The study measured fructosamine levels, 5 blood glucose levels per day, as well as looking at the adherance to the treatment plan and fear of hypoglycemia. The results suggested that the insulin pump at night improved overall blood sugar control as well as the blood sugar levels at breakfast, bed and overnight, without increasing hypoglycemia.

Comments: Although this study was small, it was well designed. The results suggest a possible solution to the problem of overnight hypoglycemia and morning hyperglycemia in children who are not yet ready to wear an insulin pump independently. In addition, this study may be useful to mature patients who have been reluctant to use an insulin pump due to lifestyle issues (life guards, for example).

LM

Posted July 3, 1999



                 
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