Continuous Subcutaneous Insulin Infusion Characteristics in Type 1 Diabetes Children and Adolescents in Qatar

Diabetes Therapy, Sep 2018

Aim To describe continuous subcutaneous insulin infusion (CSII) characteristics in type 1 diabetes mellitus (T1DM) children and adolescents using a standardized protocol in routine clinical settings in Qatar. Methods A total of 138 T1DM patients (62 males; 76 females; mean age 9.8 ± 3.4 years) with a mean diabetes duration of 2.4 ± 1.9 years initiated CSII (MiniMed® Veo®™ and MiniMed® 640 G insulin pumps; Medtronic, Northridge, CA, USA) in 2016 and 2017. CSII characteristics and glycated hemoglobin (HbA1c) were evaluated 1 year after treatment initiation. Results At 1 year after treatment initiation, the insulin dose had significantly increased (from 0.59 ± 0.23 to 0.74 ± 0.26 U/kg body weight per 24; P < 0.05), and the HbA1c level had significantly decreased (from 9.7 ± 1.3 to 8.1 ± 0.6%; P < 0.05). More than 92% of patients used the Bolus Wizard feature of the insulin pump at the following settings: insulin-to-carbohydrate ratio 19.2 ± 9.3 g; insulin sensitivity factor 131 ± 68 mg/dl; target range 91 ± 9.3–135 ± 14.2 mg/dl; active insulin time 3.8 ± 0.8 h. Conclusion Our results show that CSII may significantly improve glucose control in T1D children and adolescents who use a standardized protocol. A reduction of HbA1c by − 1.6% was achieved at 1 year after CSII initiation. These results need to be confirmed in a study with a longer duration.

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Continuous Subcutaneous Insulin Infusion Characteristics in Type 1 Diabetes Children and Adolescents in Qatar

Diabetes Therapy October 2018, Volume 9, Issue 5, pp 2091–2098 | Cite as Continuous Subcutaneous Insulin Infusion Characteristics in Type 1 Diabetes Children and Adolescents in Qatar AuthorsAuthors and affiliations Goran PetrovskiFawziya Al KhalafKhalid HussainJudith CampbellAhmed El Awwa Open Access Original Research First Online: 15 September 2018 145 Downloads Abstract Aim To describe continuous subcutaneous insulin infusion (CSII) characteristics in type 1 diabetes mellitus (T1DM) children and adolescents using a standardized protocol in routine clinical settings in Qatar. Methods A total of 138 T1DM patients (62 males; 76 females; mean age 9.8 ± 3.4 years) with a mean diabetes duration of 2.4 ± 1.9 years initiated CSII (MiniMed® Veo®™ and MiniMed® 640 G insulin pumps; Medtronic, Northridge, CA, USA) in 2016 and 2017. CSII characteristics and glycated hemoglobin (HbA1c) were evaluated 1 year after treatment initiation. Results At 1 year after treatment initiation, the insulin dose had significantly increased (from 0.59 ± 0.23 to 0.74 ± 0.26 U/kg body weight per 24; P < 0.05), and the HbA1c level had significantly decreased (from 9.7 ± 1.3 to 8.1 ± 0.6%; P < 0.05). More than 92% of patients used the Bolus Wizard feature of the insulin pump at the following settings: insulin-to-carbohydrate ratio 19.2 ± 9.3 g; insulin sensitivity factor 131 ± 68 mg/dl; target range 91 ± 9.3–135 ± 14.2 mg/dl; active insulin time 3.8 ± 0.8 h. Conclusion Our results show that CSII may significantly improve glucose control in T1D children and adolescents who use a standardized protocol. A reduction of HbA1c by − 1.6% was achieved at 1 year after CSII initiation. These results need to be confirmed in a study with a longer duration. KeywordsCSII Glucose control Type 1 diabetes  Enhanced Digital Features To view enhanced digital features for this article go to  https://doi.org/10.6084/m9.figshare.7054019. Introduction Type 1 diabetes mellitus (T1DM) is a chronic condition that is generally diagnosed in children and adolescents. Its incidence and prevalence is increasing worldwide [1, 2]. The general goals of the treatment of T1D are to maintain blood glucose levels as normal as possible through intensive insulin therapy, to reduce the frequency of hypoglycemia, to prevent serious long-term complications, and to improve the quality of life [3, 4]. Continuous subcutaneous insulin infusion (CSII), as one of the treatment options for T1DM, can improve glucose control [5, 6] with fewer hypoglycemic events [7, 8], decrease glycemic variability, and improve the quality of life of the patient. Scientific and technological developments in CSII and continuous glucose monitoring (CGM) with such functions as alarms for high and low glucose levels, predictive low glucose suspend (PLGS), and low glucose suspend (LGS) have resulted in a substantial increase in the use of insulin pumps worldwide [9, 10, 11]. Suspending basal insulin delivery in response to sensor-detected low glucose levels is an established strategy to reduce the severity and duration of hypoglycemic events [12, 13, 14], and suspending basal insulin delivery in response to predicted hypoglycemia (PLGS) has been tested in studies using various configurations of pumps, sensors, induction protocols, and algorithms [15, 16]. Over the past three decades, major social and economic changes have transformed many of the countries in the Middle East. Qatar has undergone rapid economic growth and urbanization associated with reduced infant mortality and increasing life expectancy [17]. Healthcare authorities have made diabetes prevention and treatment a national priority. Insulin pumps and glucose sensors are reimbursed at different levels: full reimbursement for Qatari Nationals; partial reimbursement for insurance holders; and charity support for patients from lower socio-economic groups. Sidra Medicine in Doha is a private institution that provides government services and is the only center in Qatar that provides treatment for children with T1DM below 18 years of age. More than 900 children with diabetes have been treated at our institution. The objective of this study was to describe CSII characteristics in T1D children using a standardized protocol in routine clinical settings in Qatar. Methods This retrospective and cross-sectional study was conducted by the Pediatric Endocrine Division, Sidra Medicine, Doha, Qatar. The study enrolled all T1D children and adolescents who started using an insulin pump (MiniMed® 640 G or MiniMed® Veo™; Medtronic, Northridge, CA, USA) in 2016 and 2017. In this study, for the patient to be started on CSII he/she had to meet one of the following criteria: inadequate glycemic control with multiple daily insulin injections (MDI); recurrent hyperglycemia; dawn phenomenon; recurrent severe hypoglycemia; frequent diabetic ketoacidosis (DKA), erratic blood glucose; lifestyle flexibility. Patients were excluded from (...truncated)


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Goran Petrovski, Fawziya Al Khalaf, Khalid Hussain, Judith Campbell, Ahmed El Awwa. Continuous Subcutaneous Insulin Infusion Characteristics in Type 1 Diabetes Children and Adolescents in Qatar, Diabetes Therapy, 2018, pp. 2091-2098, Volume 9, Issue 5, DOI: 10.1007/s13300-018-0510-5