Characterization of metabolic responders on CSII treatment amongst children and adolescents in Denmark from 2007 to 2013
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Characterization of metabolic responders on CSII treatment amongst children and adolescents in Denmark from 2007 to 2013. / Overgaard Ingeholm, I; Svensson, J; Olsen, B; Lyngsøe, L; Thomsen, J; Johannesen, J; DSBD.
I: Diabetes Research and Clinical Practice, Bind 109, Nr. 2, 08.2015, s. 279-86.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Characterization of metabolic responders on CSII treatment amongst children and adolescents in Denmark from 2007 to 2013
AU - Overgaard Ingeholm, I
AU - Svensson, J
AU - Olsen, B
AU - Lyngsøe, L
AU - Thomsen, J
AU - Johannesen, J
AU - DSBD
N1 - Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
PY - 2015/8
Y1 - 2015/8
N2 - AIM: This prospective study aimed to identify and estimate the frequency of responders offered Continuous subcutaneous insulin infusion (CSII) from baseline data and during follow-up, and secondly to characterize CSII users with good adherence to pump therapy among 463 children and adolescents with Type 1 diabetes mellitus.METHODS: A response was defined as lowering HbA1c with 1% or achieving an HbA1c<7.5% (58 mmol/mol). Good adherence was defined as measuring ≥7 self monitored blood glucoses (SMBGs) and taking ≥7 boluses daily. Logistic regression was used to estimate the effect of demographic and clinical variables prior to and during pump treatment.RESULTS: At 24 months follow-up 32% qualified as responders. Stratifying for age at onset, 45% of the children aged <6 yrs qualified as responders vs. 32% and 28% of the youngsters and adolescents aged 6-12 yrs. and 12-19 yrs., respectively (p=0.02). Responders were characterized by their HbA1c-level at pump onset (p=0.001), taking more daily boluses (7.64 ± 3.33 vs. 6.40 ± 3.18 p=0.003) and measuring more SMBGs per day at follow-up (6.88 ± 2.35 vs. 6.31 ± 2.54 p=0.03). The incidence of severe hypoglycemia decreased from 14.3 to 3.3 events per 100 person years (p<0.0001). Twenty percent did not respond despite a good adherence toward CSII therapy.CONCLUSION: Age <6 years, high or low HbA1c at pump initiation and number of daily boluses were associated with improved or sustained near-normal metabolic outcome. The incidence of severe hypoglycemia was significantly reduced. Twenty percent of the population had good adherence without any metabolic improvement.
AB - AIM: This prospective study aimed to identify and estimate the frequency of responders offered Continuous subcutaneous insulin infusion (CSII) from baseline data and during follow-up, and secondly to characterize CSII users with good adherence to pump therapy among 463 children and adolescents with Type 1 diabetes mellitus.METHODS: A response was defined as lowering HbA1c with 1% or achieving an HbA1c<7.5% (58 mmol/mol). Good adherence was defined as measuring ≥7 self monitored blood glucoses (SMBGs) and taking ≥7 boluses daily. Logistic regression was used to estimate the effect of demographic and clinical variables prior to and during pump treatment.RESULTS: At 24 months follow-up 32% qualified as responders. Stratifying for age at onset, 45% of the children aged <6 yrs qualified as responders vs. 32% and 28% of the youngsters and adolescents aged 6-12 yrs. and 12-19 yrs., respectively (p=0.02). Responders were characterized by their HbA1c-level at pump onset (p=0.001), taking more daily boluses (7.64 ± 3.33 vs. 6.40 ± 3.18 p=0.003) and measuring more SMBGs per day at follow-up (6.88 ± 2.35 vs. 6.31 ± 2.54 p=0.03). The incidence of severe hypoglycemia decreased from 14.3 to 3.3 events per 100 person years (p<0.0001). Twenty percent did not respond despite a good adherence toward CSII therapy.CONCLUSION: Age <6 years, high or low HbA1c at pump initiation and number of daily boluses were associated with improved or sustained near-normal metabolic outcome. The incidence of severe hypoglycemia was significantly reduced. Twenty percent of the population had good adherence without any metabolic improvement.
KW - Adolescent
KW - Blood Glucose Self-Monitoring
KW - Child
KW - Denmark
KW - Diabetes Mellitus, Type 1
KW - Female
KW - Hemoglobin A, Glycosylated
KW - Humans
KW - Hypoglycemic Agents
KW - Incidence
KW - Injections, Subcutaneous
KW - Insulin
KW - Insulin Infusion Systems
KW - Male
KW - Prospective Studies
U2 - 10.1016/j.diabres.2015.05.027
DO - 10.1016/j.diabres.2015.05.027
M3 - Journal article
C2 - 26070217
VL - 109
SP - 279
EP - 286
JO - Diabetes Research and Clinical Practice
JF - Diabetes Research and Clinical Practice
SN - 0168-8227
IS - 2
ER -
ID: 162339830