The incidence of type 1 diabetes in children under 5 years is increasing. The insulin requirements, eating regimens and reaction to invasive procedures make this group a challenging cohort to manage on multiple daily injections. NICE Guidance was amended in 2008 to include the option of using CSII at diagnosis in the under 5s.
Seven CSII starts at diagnosis have been done (from 2009 to current). CSII is initiated within 72 h from initial diagnosis, following IV insulin, allowing time to discuss treatment options with parents.
We adapted our training programme to allow parents time to adjust to the diagnosis, learn concept of carbohydrate counting, and consider the potential benefits and disadvantages of different insulin regimens. All pump starts have been done in hospital with an average stay of 5 days. Following discharge children and their families are followed up by phone and email daily for 2 weeks, weekly for 4 weeks before reverting back to routine 3 monthly clinic appointments.
Levels of knowledge and skills of ward staff have an impact on the ability and safety of commencing this treatment at diagnosis. This highlights the need for extra training of ward based nursing and medical staff for this to be a success.
Children achieve improved glycaemic control on CSII compared to MDI. A comparison of modes of insulin therapy has shown 48.3% of children using CSII achieve HbA1c <7.5% compared to 26.1% of those on MDI (2010). Children using CSII have a higher (mean 65.4) PDQOL than those on MDI (mean 53.3 P=0.003).
Emerging evidence on metabolic memory may emphasise the importance of achieving target HbA1c as soon as possible from diagnosis.
09 - 11 Nov 2011
British Society for Paediatric Endocrinology and Diabetes