1. Use of Insulin Pump in Children with Type I Diabetes Mellitus: Effect on glycemic control and Body Mass Indices (BMI).
Noura Al Hemaidi, Maryam Al Ali, Ashraf Soliman, Mahmmoud AlZyoud
The Departments of Pediatrics, Hamad Medical Center , Doha, Qatar
Introduction -Patients
RESULTS
Discussion
Experience with the pump in children however is still in its primary phase. Controlled randomized studies in children are still very few.
In addition, the use of insulin pump in our cohort of diabetic children needs a thorough investigation to decide about the benefits versus the disadvantages in our culture and hospital set-up .
Inclusion criteria:
All children with DM 1, < 14 yr, who were on insulin pump (Medtronic) for one year or more.
Exclusion criteria :
Insulin pump less than one year, other types of diabetes mellitus, renal or hepatic impairment, malnutrition (primary or secondary) or any other systemic illness
In this retrospective study all children <14 yr (n=23) with DM1,who were started on insulin pump, have been followed for one year or more in the diabetes clinic at Hamad Medical Center (HMC)
In this study, the HbA1c concentration decreased significantly after using the pump in 18 children . 5 patients showed deterioration, 3 of them didn’t use carbohydrate counting properly, 1had phobia from hypoglycemia.
BMI increased significantly in all patients after the pump in both the well-controlled and poorly-controlled groups ( p >0.05) this weight gain is due to the anabolic effect of the near-physiologically delivered insulin through the pump. However the BMI of 22/23 patients did not exceeded the 85th % .
Good dietary management and intensive education about carbohydrate count should decrease the risk of weight gain in these patients.
Three of them developed one incidence of DKA, due to pump malfunctioning ( n= 2), or patient error. After reeducation, no DKA was recorded.
3 who were developing recurrent hypoglycemia before the pump, had no hypoglycemic attack after the pump.
Summary
the effect of insulin pump on the glycemic control and BMI of 23 children with type 1 DM1 showed that after starting the pump, HbA1c concentration deceased from (9.36+/-2.02%) to (8.54+/-1.149%).The BMI increased significantly from (17.12+/-2.236) to (20.4+/-2.93). No incidence of hypoglycemia was reported in any of the patients. Three incidences of DKA were reported after the pump due to pump mal-functioning(n=2) or patient error (n=1). All patients except two showed interest to continue the pump because of desirable flexibility of their lifestyle including activity and meal times
Data Collection included:
Anthropometric data: weight, height, and BMI,
Biochemical data: HbA1c
Frequency of incidence/s of DKA and symptomatic hypoglycemia before vs after the pump
Frequency of blood glucose monitoring per day.
Three incidences of DKA was reported due to
pump malfunction( n=2) and patient error(n=1).
No symptomatic hypoglycemia was reported .
The quality of life as judjed by the patients and
Parents showed ood satisfaction because
of improvement of the quality and quantity of
daily activity and flexibility of food intake .