Early Use of Insulin Pump Therapy Beneficial for Children with Type 1 Diabetes

Clemens Kamrath, MD

Early initiation of insulin pump therapy in pediatric patients newly diagnosed with type 1 diabetes was associated with improved clinical outcomes, according to a new study.

The study, led by Clemens Kamrath, MD, Division of Pediatric Endocrinology and Diabetology, Center of Child and Adolescent Medicine, Justus Liebig University, Germany, was based on data from the Diabetes-Patienten-Verlaufsdokumentation (DPV), a multicenter, prospective diabetes follow-up registry that consists of 501 diabetes centers across several European countries.

Their aim was to assess the efficacy and outcome of early therapy initiation versus delayed initiation post-diagnosis.

“Although continuous subcutaneous insulin infusion therapy is associated with improved metabolic control compared with multiple daily insulin injections in children with type 1 diabetes, it is unclear when it is best to start it after diagnosis,” the investigators wrote.

Thus, included in their sample was a total of 8332 patients diagnosed with type 1 diabetes between 2004-2014. All patients at diagnosis represented age 6 months to 15 years old.

Kamrath and team divided the sample into 2 treatment cohorts — those who had initiated insulin pump therapy within the first 6 months of diabetes diagnosis (48.1%) and those who initiated treatment in the 2nd or 3rd year (51.9%).

Outcomes parameters included the glycated hemoglobin (HbA1c) values, cardiovascular risk profile, rates of acute complications and, hospitalizations associated with diabetes during the most recent year with insulin pump therapy.

In both groups, the median duration of diabetes during follow-up was 6.7 years (IQR, 5.1-8.7 in early cohort vs 5.0-8.7 in delayed cohort).

Patients with early initiation of therapy demonstrated an overall mean HbA1c value of 62.6 mmol/mol (95% CI 62.1-63.2)—in comparison with 64.1 mmol/mol (95% CI; 63.6-64.6; P = .0006) for the delayed therapy cohort.

Further, the early therapy cohort had lower rates of hypoglycemic coma (incidence rat [IR], 0.44 [95% CI, 0.24-0.79; P = .0064]) and hospitalization (IR, 0.86 [95% CI, 0.78-0.94; P = .0016]).

“A better cardiovascular risk profile was observed in patients with early initiation of insulin pump therapy than in those with delayed initiation,” the investigators wrote.

In particular, they noted an improved estimated mean system pressure for the early therapy initiators (117.6 mm Hg [95% CI, 117.2-117.9) when compared with the delayed initiators (118.5 mm Hg [95% CI, 118.2-118.9; P = .0007). 

The trend was similar for non-HDL cholesterol — 62.8 mg/dL (95% CI; 62.2-63.5) versus 60.6 mg/dL (95% CI, 60.0-61.2; P < .0001).

On the contrary, both groups did not differ in diastolic blood pleasure concentrations of LDL cholesterol, non-HDL cholesterol, and triglycerides; and estimated body-mass index standard deviation scores during follow-up.

Overall, they concluded by emphasizing the clinical benefit associated with early initiation of insulin pump therapy for this patient population. 

The study, “Early versus delayed insulin pump therapy in children with newly diagnosed type 1 diabetes: results from the multicentre, prospective diabetes follow-up DPV registry,” was published online in The Lancet: Child and Adolescent Health.