Continuous Subcutaneous Insulin Infusion in Children: A Pilot Study Validating a Protocol to Avoid Hypoglycemia at Initiation

Despoina Manousaki, Johnny Deladoëy, Louis Geoffroy, Patricia Olivier, Despoina Manousaki, Johnny Deladoëy, Louis Geoffroy, Patricia Olivier

Abstract

Background: The occurrence of hypoglycemia and hyperglycemia during the first days after transition to continuous subcutaneous insulin infusion (CSII) in patients with type 1 diabetes has not been systematically studied in children. The aim of this prospective study was to demonstrate that the protocol applied in our diabetes clinic is safe at CSII initiation in children.

Methods: We assessed 22 pediatric patients with type 1 diabetes, using continuous glucose monitoring (CGM) before and after CSII initiation (±3 days).

Results: After CSII initiation, there was no difference in the rates of hypoglycemic events expressed as relative rates (RRs) per person-reading (RR = 0.85, p = 0.52, 95% CI 0.52-1.39), as well as in the number of prolonged hypoglycemic events (>1 h) per day (RR = 1.12, p = 0.56, 95% CI 0.75-1.68). We observed only a trend toward prolonged episodes of hyperglycemia after pump initiation (RR = 1.52, p = 0.06, 95% CI 0.97-2.35).

Conclusion: Our study is the first to assess, through CGM and in a prospective way, the impact of a CSII initiation protocol on glycemic values. Our protocol provides a safe model to avoid hypoglycemia at CSII initiation in children.

Clinical trial registration: www.ClinicalTrials.gov, identifier NCT01840358.

Keywords: continuous glucose monitoring; continuous subcutaneous insulin infusion; hypoglycemia; pediatrics; type 1 diabetes.

Figures

Figure 1
Figure 1
CHU Sainte-Justine protocol for calculation of insulin dose at continuous subcutaneous insulin infusion (CSII) initiation. 1Rule of 500 [used to calculate the carbohydrate factor (grams of carbohydrate per unit of insulin)]: 500 divided by the TDI (11). 2Rule of 100 (used to calculate the sensitivity factor): sensitivity factor equal to 100 divided by the total daily insulin (TDI) dose (11).
Figure 2
Figure 2
Breakdown of study subjects through inclusion and exclusion criteria.

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