Key publication slides Danne T, et al. Establishing glycaemic control with continuous subcutaneous insulin infusion in children and adolescents with type 1 diabetes: Experience of the PedPump Study in 17 countries. Diabetologia. 2008;51:1594-601. Key publication slides No FXCX

Background and Objectives There are many challenges to achieving good glycaemic control in paediatric patients with T1D Variable patterns of eating and activity1 Unpredictable insulin absorption in young children2 Adherence to therapy and monitoring in adolescents1,3 CSII (also known as insulin pump therapy) has been shown to improve glycaemic control compared with multiple daily injections; CSII use in paediatric patients is increasing4,5 The purpose of this study was to characterize the use of CSII in a real-world setting in paediatric patients with T1D6 1. Silverstein J, et al. Diabetes Care. 2005;28:186-212. 2. Acerini CI, et al. Diabetologia. 2000;43:61-8. 3. Weissberg-Benchell J, et al. Diabetes Care. 1995;18:77-82. 4. Misso ML, et al. Cochrane Database Syst Rev. 2010;1:CD005103. 5. Ahern JAH, et al. Pediatr Diabetes. 2002;3:10-5. 6. Danne T, et al. Diabetologia. 2008;51:1594-601. CSII, continuous subcutaneous insulin infusion; T1D, type 1 diabetes.

Study Design Open, cross-sectional, retrospective study Data from 1,086 children (preschool and preadolescent) and adolescents treated at 30 treatment centres in 17 countries Eligible patients had T1D, were using CSII, and had 90 days of data storage capacity in a compatible CSII system Clinical data were collected at clinic visits HbA1c was measured by a central laboratory HbA1c, glycated haemoglobin A1c. Danne T, et al. Diabetologia. 2008;51:1594-601.

Results: Patient Characteristics Parametera Preschool (n = 148) Preadolescent (n = 326) Adolescent (n = 612) Male/female, % 54/46 52/48 41/59 Body weight, kg 18.3 34.5 58.9 Height, cm 104.8 139.1 164.8 Body mass index, kg/m2 16.6 17.6 21.5 Duration of diabetes, years 2.5 4.9 7.3 Duration of CSII therapy, years 1.7 1.9 2.1 Total daily insulin dose, units/kg, median (range) 0.64 (0.01–8.9) 0.69 (0.11–3.11) 0.80 (0–2.22) Number of daily boluses, n, median (range) 8.0 (2.3–19.6) 7.7 (3.1–21.4) 6.3 (1.5–19.6) Daily bolus/total, %, median (range) 67.5 (27.1–100) 59.9 (22.6–98.4) 55.3 (8.27–97.7) aData represent mean values, except for gender proportions or stated otherwise. Danne T, et al. Diabetologia. 2008;51:1594-601.

Results: Glycaemic Control Was Better in Preschool Children Than Adolescents Danne T, et al. Diabetologia. 2008;51:1594-601.

Results: Correlation Between HbA1c and Bolus Insulin Lower HbA1c was associated with higher mean number of daily boluses (r = −0.367; p < 0.001) Lower HbA1c was associated with higher proportion of total daily dose given as bolus (r = −0.313; p < 0.001) HbA1c in patients in whom basal insulin constituted < 50% vs > 50% of total daily insulin dose: 7.8% vs 8.5%; p < 0.01 Total daily insulin dose did not correlate with HbA1c (p = 0.09) Danne T, et al. Diabetologia. 2008;51:1594-601.

Results: Relationship Between HbA1c and the Number of Insulin Boluses Per Day Danne T, et al. Diabetologia. 2008;51:1594-601.

Results: Safety Event rate, per 100 patient-years Preschool (n = 148) Preadolescent (n = 326) Adolescent (n = 612) Overall (N = 1,086) Severe hypoglycaemia 10.81 8.59 5.22 6.63 Ketoacidosis 2.70 9.88 5.23 6.26 Danne T, et al. Diabetologia. 2008;51:1594-601.

Conclusions In this large international survey of paediatric patients with T1D using CSII: CSII therapy was well tolerated, with low rates of severe hypoglycaemia and ketoacidosis Sufficient substitution of basal and prandial insulin was associated with better glycaemic control Use of frequent daily boluses and a lower proportion of basal insulin was associated with better glycaemic control than fewer daily boluses and a higher proportion of basal insulin Danne T, et al. Diabetologia. 2008;51:1594-601.