Is Insulin Pump Therapy Better Than Insulin Injection Therapy for Toddlers With Type 1 Diabetes?

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A randomly controlled trial of insulin pump therapy in young children with type 1 diabetes, by L.A. Fox and colleagues. Diabetes Care 28:1277-1281, 2005.

What is the problem and what is known about it so far?

For a number of reasons, it's hard to achieve good blood glucose control in infants and toddlers with type 1 diabetes: how infants' bodies will react to insulin is hard to predict, and the eating and activity patterns of young children change often. These things, among others, can lead to widely changing blood glucose levels in infants and toddlers with type 1 diabetes.

Why did the researchers do this particular study?

There isn't much information that compares insulin pump therapy with traditional insulin injection therapy in toddlers and infants. In addition, there's very little information that looks at quality-of-life issues, such as parents' stress levels, among the families of toddlers and infants with type 1 diabetes.

The researchers wanted to see if insulin pump therapy might be better than insulin injection therapy. They designed the study to see whether the use of insulin pump therapy in young children improves diabetes control, lowers the frequency of hypoglycemia (or blood glucose levels that are too low), and improves the family’s quality of life.

Who was studied?

Twenty-six children who had type 1 diabetes for at least 6 months. The children were between 12 and 72 months old.

How was the study done?

The children were given either their usual insulin injection therapy or insulin pump therapy for 6 months. After 6 months, the children on insulin injection therapy were given insulin pump therapy. The researchers measured the children's A1C (a measure of long-term blood glucose control), their average blood glucose level, how many times they had low blood glucose levels, quality-of-life measures, and how parents adjusted to new routines.

What did the researchers find?

Eleven children from each group completed the study. At the beginning of the study, there were no differences in A1C, average blood glucose, the age of the children, the number of boys and girls, how long the children had diabetes, or parental quality of life between the insulin injection and insulin pump groups. Likewise, after 6 months, A1C, average blood glucose, and quality of life were similar between the two groups. A1C and average blood glucose did not change in either group after 6 months, and how many times the children had dangerously low blood glucose, had high blood glucose, and had to go to the hospital was similar between the two groups throughout the study.

Children in the insulin pump group had low blood glucose levels more often, and quality-of-life measures improved among fathers of children in the insulin pump group. Mothers of children in the insulin injection group felt stressed more often during the 6 months.

What were the limitations of the study?

This study looked at only 11 children in each group. The researchers think that a group of 40-60 children is needed to fully compare the effects of these therapies on average blood glucose, A1C, and the likelihood of hypoglycemia.

What are the implications of the study?

In this study, insulin pump therapy was safe and well tolerated in toddlers and young children with type 1 diabetes, and it was just as good as insulin injection therapy for maintaining good diabetes control. More studies are needed, though, to fully examine the benefits of using insulin pump therapy in very young children.

FOR MORE INFORMATION

Diabetes in Infants and Toddlers

Insulin Pumps

A two-centered randomized controlled feasibility trial of insulin pump therapy in young children with diabetes, by D.W. Wilson and colleagues. Diabetes Care 28:15–19, 2005.

Smart Pumping for People with Diabetes. Howard Wolpert, Ed. (Alexandria, Va., ADA, 2002).