Evaluation of Glycemic Control before and after Initiation of Insulin Pump Therapy in Children and Adolescents with Type 1 Diabetes

Abstract

Introduction: Children and adolescents with type 1 diabetes (T1DM) are managed with multiple daily injections of insulin (MDI) or with an insulin pump. Understanding the advantages and disadvantages of each treatment modality is important for personalizing the diabetes care plan and meeting patients' various needs. Aim: To evaluate the effect of insulin pump therapy on glycemic control and growth parameters in children and adolescents with T1DM in a Middle Eastern cohort. Secondary objectives included evaluating the effect of insulin pump therapy on insulin requirements and diabetes-related ketoacidosis episodes. Methods: This is a retrospective cohort study conducted at King Abdullah Specialized Children's Hospital in Riyadh, Saudi Arabia. Our cohort consisted of children and adolescents, between the ages of 1 and 14 years, who had T1DM and who were treated with insulin pump therapy for at least a year. Data collected included age, duration of DM and pump therapy, HbA1C levels, total daily insulin dose, height, weight, and body mass index (BMI) z-scores, both before and after initiation of pump treatment. Results: A total of 54 individuals, with a mean age of 7.8 (+/- 2.9) years and a mean diabetes duration of 3.5 years, were included in the study. After initiation of insulin pump therapy, there was a clinically and statistically significant improvement in HbA1c levels, with a drop of 0.70% (+/- 1.10%; p-value < 0.0001); the average drop was 0.57% (p-value 0.005) upon adjusting for baseline characteristics in a mixed-model regression. An increase in both weight and BMI z-score, by 0.26 (p-value 0.028) and 0.31 (p-value 0.005), respectively, was observed. Continuous glucose monitoring (CGM) status was similar in 72.2%, before and after pump therapy. There was no statistically significant change in total daily dose of insulin (units/kg/day) and no statistically significant difference in diabetes-related ketoacidosis events. Conclusion: Insulin pump therapy was associated with improved glycemic control in our cohort of children and adolescents with T1DM. The observed increases in weight and BMI z-scores may reflect improvements in metabolic control rather than a direct effect of pump therapy, highlighting the importance of nutritional monitoring and healthy lifestyle counseling. A personalized approach should be considered when formulating the diabetes care plan.