Age-Specific Advantages of Continuous Subcutaneous Insulin Infusion as Compared With Multiple Daily Injections in Pediatric Patients

In the past years, treatment with continuous subcutaneous insulin infusion (CSII) has been increasingly used in younger age-groups of patients with type 1 diabetes, and several studies have reported advantages of CSII, but little information is based on case-controlled analyses (1,2). Although short-term effects of CSII were described (3), there is no clear evidence whether its use leads to a continuous improvement of glycemic control. In order to evaluate long-term effects, we performed a matched-pair analysis comparing the outcome in young patients with CSII versus multiple daily injection (MDI) over 1 year of treatment under routine conditions representative of a pediatric diabetes clinic. Fifty-nine of 85 patients starting on CSII from 2001 to 2004 with treatment duration of at least 1 year were eligible. The control cohort was comprised of 580 patients treated with MDI within the same time period. Fifty-two matched pairs could be identified fulfilling the matching criteria: sex, age (± 1 year), diabetes duration (± 1 year), and HbA1c (A1C) level (± 0.3%) at study entry (start of CSII). In the case of multiple matched MDI subjects, only the subject closest to A1C and diabetes duration was selected. Patients with MDI received treatment based on the basal-bolus principle and had 3.5 ± 0.9 injections per day. Forty-one patients (79%) used NPH, eight …