TY - JOUR
T1 - Factors affecting improved glycaemic control in youth using insulin pumps
AU - Wilkinson, J.
AU - McFann, K.
AU - Chase, H. P.
PY - 2010/10
Y1 - 2010/10
N2 - Aims The purpose of this study was to evaluate factors associated with insulin pump therapy resulting in lower HbA1c levels in young people with Type 1 diabetes mellitus. Methods Insulin pumps were downloaded from 150 youth (81 male), ages 5-20 years. Consecutive insulin pump downloads, 3 months apart, were available for 85 (43 male) of the 150 youth and changes in pump use were correlated with changes (≥ 0.5%, ≥ 6 mmol/mol) in HbA1c levels. Results Using cross-sectional data, lower HbA1c values correlated with use of more frequent daily insulin boluses (r = -0.46, P < 0.0001) and more frequent blood glucose checks/day (r = -0.35, P < 0.0001). Young people with HbA1c levels < 7.5% (58 mmol/mol) vs. values of 7.5-9.0% (58-75 mmol/mol) or ≥ 9.0% (75 mmol/mol) tested blood glucose more frequently/day (P < 0.0001), bolused more frequently/day (P < 0.0001), reported more grams of carbohydrates eaten/day (P < 0.05) and had a higher per cent bolus insulin/day (P < 0.05) compared with the ≥ 9.0% of youth. Using longitudinal data, 48 of 85 patients had a change in HbA1c level of ≥ 0.5% (6 mmol/mol) between downloads (24 improved). Increased bolus insulin (OR = 1.15, P = 0.03) and time of temporary basal rate use (OR = 1.017, P = 0.01) predicted ≥ 0.5% (6 mmol/mol) decrease in HbA1c in logistic regression. Conclusions This study emphasizes the importance of blood glucose testing, of bolus insulin administration and of an increase in the time of temporary basal rate use in relation to improving glycaemic control.
AB - Aims The purpose of this study was to evaluate factors associated with insulin pump therapy resulting in lower HbA1c levels in young people with Type 1 diabetes mellitus. Methods Insulin pumps were downloaded from 150 youth (81 male), ages 5-20 years. Consecutive insulin pump downloads, 3 months apart, were available for 85 (43 male) of the 150 youth and changes in pump use were correlated with changes (≥ 0.5%, ≥ 6 mmol/mol) in HbA1c levels. Results Using cross-sectional data, lower HbA1c values correlated with use of more frequent daily insulin boluses (r = -0.46, P < 0.0001) and more frequent blood glucose checks/day (r = -0.35, P < 0.0001). Young people with HbA1c levels < 7.5% (58 mmol/mol) vs. values of 7.5-9.0% (58-75 mmol/mol) or ≥ 9.0% (75 mmol/mol) tested blood glucose more frequently/day (P < 0.0001), bolused more frequently/day (P < 0.0001), reported more grams of carbohydrates eaten/day (P < 0.05) and had a higher per cent bolus insulin/day (P < 0.05) compared with the ≥ 9.0% of youth. Using longitudinal data, 48 of 85 patients had a change in HbA1c level of ≥ 0.5% (6 mmol/mol) between downloads (24 improved). Increased bolus insulin (OR = 1.15, P = 0.03) and time of temporary basal rate use (OR = 1.017, P = 0.01) predicted ≥ 0.5% (6 mmol/mol) decrease in HbA1c in logistic regression. Conclusions This study emphasizes the importance of blood glucose testing, of bolus insulin administration and of an increase in the time of temporary basal rate use in relation to improving glycaemic control.
KW - bolus injection
KW - continuous subcutaneous insulin infusion
KW - temporary basal rate
KW - Type 1 diabetes
KW - youth
UR - http://www.scopus.com/inward/record.url?scp=77956865474&partnerID=8YFLogxK
U2 - 10.1111/j.1464-5491.2010.03068.x
DO - 10.1111/j.1464-5491.2010.03068.x
M3 - Article
C2 - 20854386
AN - SCOPUS:77956865474
SN - 0742-3071
VL - 27
SP - 1174
EP - 1177
JO - Diabetic Medicine
JF - Diabetic Medicine
IS - 10
ER -