This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Campbell, F. Search for Related Content Social Bookmarking                         What's this?

Review: The pros and cons of continuous subcutaneous insulin infusion (CSII) therapy in the paediatric population and practical considerations when choosing and initiating CSII in children

Department of Paediatrics, Leeds Teaching Hospitals Trust, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK, Fiona.Campell{at}leedstri.nhs.uk

CSII (continuous subcutaneous insulin infusion), has the potential to improve long-term glycaemic control in many patients with type 1 diabetes. CSII may also reduce the incidence of hypoglycaemic episodes, especially in patients prone to hypoglycaemia, and may reduce glycaemic variability. A pivotal advantage of CSII over MDIs (multiple daily injection), especially in children, is its superior convenience and flexibility. Programmable basal rates are delivered automatically and with unprecedented precision, while bolus doses can easily be used to titrate insulin exposure around meals and activities and to correct hyperglycaemia. The subcutaneous cannula needs to be re-sited only once every 2—3 days. In light of these advantages, CSII is generally preferred by children and parents. Careful patient selection is crucial, however, as CSII users and their carers must be willing and able to use the equipment correctly, as well as to perform general aspects of intensive self-care. Accordingly, CSII should be initiated only by a specialist, multidisciplinary team and in conjunction with a structured, ongoing educational and monitoring programme. Factors affecting the selection of a particular pump include the size and weight of the device, ease of use, range of dose modes and increments, cost, warranty and customer services.

Key Words: continuous insulin infusion • diabetes mellitus • insulin • paediatrics • pump

References

• National Institute for Health and Clinical Excellence. NICE technology appraisal guidance 151. Continuous subcutaneous insulin infusion for the treatment of diabetes mellitus (review of technology appraisal guidance 57). London: National Institute for Health and Clinical Excellence, July 2008. http://www.nice.org.uk/TA151 (Accessed 23 July 2008).
• Weinzimer SA, Swan KL, Sikes KA et al. Emerging evidence for the use of insulin pump therapy in infants, toddlers, and preschool-aged children with type 1 diabetes. Pediatr Diabetes 2006; 7(suppl 4):15-19.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Colquitt JL, Green C., Sidhu MK et al. Clinical and cost-effectiveness of continuous subcutaneous insulin infusion for diabetes. Health Technol Assess 2004; 8(iii):1-171.[Medline] [Order article via Infotrieve]
• Jeitler K., Horvath K., Berghold A. et al. Continuous subcutaneous insulin infusion versus multiple daily insulin injections in patients with diabetes mellitus: systematic review and meta-analysis. Diabetologia 2008; 51:941-51.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Pickup JC, Sutton AJ Severe hypoglycaemia and glycaemic control in type 1 diabetes: meta-analysis of multiple daily insulin injections versus continuous subcutaneous insulin infusion. Diabet Med 2008; 25: 765-74.[Medline] [Order article via Infotrieve]
• Doyle EA, Weinzimer SA, Steffen AT et al. A randomized, prospective trial comparing the efficacy of continuous subcutaneous insulin infusion with multiple daily injections using insulin glargine. Diabetes Care 2004; 27:1554-8.[Abstract/Free Full Text]
• Cohen D., Weintrob N., Benzaquen H. et al. Continuous subcutaneous insulin infusion versus multiple daily injections in adolescents with type I diabetes mellitus: a randomized open crossover trial. J Pediatr Endocrinol Metab 2003; 16:1047-50.[Web of Science][Medline] [Order article via Infotrieve]
• Weintrop N., Benzaquen H., Galatzer A. et al. Comparison of continuous subcutaneous insulin infusion and multiple daily injection regimens in children with type 1 diabetes: a randomized open crossover trial. Pediatrics 2003; 112:559-64.[Abstract/Free Full Text]
• DiMeglio LA, Pottorff TM, Boyd SR et al. A randomized, controlled study of insulin pump therapy in diabetic preschoolers. J Pediatr 2004; 145:380-4.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Fox LA, Buckloh LM, Smith SD et al. A randomized controlled trial of insulin pump therapy in young children with type 1 diabetes. Diabetes Care 2005; 28:1277-81.[Abstract/Free Full Text]
• Weinzimer SA, Ahern JH, Doyle EA et al. Persistence of benefits of continuous subcutaneous insulin infusion in very young children with type 1 diabetes: a follow-up report. Pediatrics 2004; 114:1601-5.[Abstract/Free Full Text]
• Sulli N., Shashaj B. Long-term benefits of continuous subcutaneous insulin infusion in children with Type 1 diabetes: a 4-year follow-up. Diabet Med 2006; 23:900-6.[Medline] [Order article via Infotrieve]
• Jakisch BI, Wagner VM, Heidtmann B. et al. Comparison of continuous subcutaneous insulin infusion (CSII) and multiple daily injections (MDI) in paediatric Type 1 diabetes: a multicentre matched-pair cohort analysis over 3 years. Diabet Med 2008; 25:80-5.[Medline] [Order article via Infotrieve]
• McVean JJF, Eickhoff JC, MacDonald MJ Factors correlating with improved A1C in children using continuous subcutaneous insulin infusion. Diabetes Care 2007; 30:2499-500.[Free Full Text]
• Pickup JC, Kidd J., Burmiston S. et al. Determinants of glycaemic control in type 1 diabetes during intensified therapy with multiple daily insulin injections or continuous subcutaneous insulin infusion: importance of blood glucose variability. Diabetes Metab Res Rev 2006; 22:232-7.[Medline] [Order article via Infotrieve]
• Alemzadeh R., Palma-Sisto P., Holzum M. et al. Continuous subcutaneous insulin infusion attenuated glycemic instability in preschool children with type 1 diabetes mellitus. Diabetes Technol Ther 2007; 9:339-47.[Medline] [Order article via Infotrieve]
• Bruttomesso D., Crazzolara D., Maran A. et al. In Type 1 diabetic patients with good glycaemic control, blood glucose variability is lower during continuous subcutaneous insulin infusion than during multiple daily injections with insulin glargine. Diabet Med 2008; 25:326-32.[CrossRef][Medline] [Order article via Infotrieve]
• McCarthy AM, Lindgren S., Mengeling MA et al. Factors associated with academic achievement in children with type 1 diabetes. Diabetes Care 2003; 26:112-17.[Abstract/Free Full Text]
• Martin DD, Davis EA, Jones TW Acute effects of hyperglycaemia in children with type 1 diabetes mellitus: the patient's perspective. J Pediatr Endocrinol Metab 2006; 19:927-36.[Medline] [Order article via Infotrieve]
• Weinzimer SA, Ternand C., Howard C. et al. A randomized trial comparing continuous subcutaneous insulin infusion of insulin aspart versus insulin lispro in children and adolescents with type 1 diabetes. Diabetes Care 2008; 31:210-15.[Abstract/Free Full Text]
• Hoogma RP, Hammond PJ, Gomis R. et al. Comparison of the effects of continuous subcutaneous insulin infusion (CSII) and NPH-based multiple daily insulin injections (MDI) on glycaemic control and quality of life: results of the 5-nations trial. Diabet Med 2006; 23:141-7.[CrossRef][Medline] [Order article via Infotrieve]
• Scheidegger U., Allemann S., Scheidegger K. et al. Continuous subcutaneous insulin infusion therapy: effects on quality of life. Swiss Med Wkly 2007; 137:476-82.[Medline] [Order article via Infotrieve]
• EQuality1 Study Group: Evaluation of QUALITY of Life and Costs in Diabetes Type 1, Nicolucci A., Maione A. et al. Quality of life and treatment satisfaction in adults with Type 1 diabetes: a comparison between continuous subcutaneous insulin infusion and multiple daily injections. Diabet Med 2008; 25:213-20.[Medline] [Order article via Infotrieve]
• McMahon SK, Airey FL, Marangou DA et al. Insulin pump therapy in children and adolescents: improvements in key parameters of diabetes management including quality of life. Diabet Med 2005; 22:92-6.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Júlíusson PB, Graue M., Wentzel-Larsen T. et al. The impact of continuous subcutaneous insulin infusion on health-related quality of life in children and adolescents with type 1 diabetes. Acta Paediatr 2006; 95:1481-7.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Opipari-Arrigan L., Fredericks EM, Burkhart N. et al. Continuous subcutaneous insulin infusion benefits quality of life in preschool-age children with type 1 diabetes mellitus. Pediatr Diabetes 2007; 8:377-83.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Weintrop N., Benzaquen H., Galatzer A. et al. Comparison of continuous subcutaneous insulin infusion and multiple daily injection regimens in children with type 1 diabetes: a randomized open crossover trial. Pediatrics 2003; 112:559-64.[Abstract/Free Full Text]
• Guilhem I., Leguerrier AM, Lecordier F. et al. Technical risks with subcutaneous insulin infusion. Diabetes Metab 2006; 32:279-84.[Medline] [Order article via Infotrieve]
• Ponder SW, Skyler JS, Kruger DF et al. Unexplained hyperglycemia in continuous subcutaneous insulin infusion: evaluation and treatment. Diabetes Educ 2008; 34:327-33.[Abstract/Free Full Text]
• Hanas R., Ludvigsson J. Hypoglycemia and ketoacidosis with insulin pump therapy in children and adolescents. Pediatr Diabetes 2006; 7(suppl 4):32-8.[Medline] [Order article via Infotrieve]
• Cope JU, Morrison AE, Samuels-Reid J. Adolescent use of insulin and patient-controlled analgesia pump technology: a 10-year Food and Drug Administration retrospective study of adverse events. Pediatrics 2008; 121:e1133-8.[Abstract/Free Full Text]

The British Journal of Diabetes & Vascular Disease, Vol. 8, No. 1 suppl, S6-S10 (2008)
DOI: 10.1177/1474651408098138


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Campbell, F. Search for Related Content Social Bookmarking                         What's this?