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Failure of glycated hemoglobin drop after continuous subcutaneous insulin infusion initiation may indicate patients who discontinue: a 4-year follow-up study in children and adolescents with type 1 diabetes

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Abstract

Continuous subcutaneous insulin infusion (CSII) is effective and safe in children and adults with type 1 diabetes. Notwithstanding, some patients decide to discontinue using CSII. We evaluated the discontinuation rate, and its related factors, in a large group of children and adolescents with type 1 diabetes using CSII in Italy. Data on all patients with type 1 diabetes younger than 18 years were collected by 28 Pediatric Diabetologic referral Centers located throughout Italy. The primary endpoint was to measure the discontinuation rate using CSII. Among the study population (n = 6,644), 985 (14.8%) were using CSII. Sixty patients discontinued using CSII, representing the 6.1%. The discontinuation rate significantly increased (P = 0.002) with age: 0–6 years, 1/84 (1.2%), 7–11 years, 8/262 (3.1%), 12–18 years, 51/579 (8.8%). The average time to discontinuation was 1.8 ± 1.4 years. The average age of patients who discontinued using CSII was higher than in patients still on CSII (12.1 ± 3.2 vs. 10.3 ± 3.8, P = 0.0001), while their diabetes duration was significantly shorter (8.6 ± 2.7 vs. 10.2 ± 3.7, P = 0.0001). HbA1c decreased only in patients still on CSII (8.7 ± 1.3% vs. 7.8 ± 1.3%, P = 0.02), but not in patients who discontinued using CSII (8.5 ± 1.6% vs. 8.2 ± 1.3%, P = 0.213). HbA1c might be one important indicator helpful to identify patients at higher risk discontinuing using CSII.

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Conflict of interest

None of the authors (neither the one listed in the title page nor the one listed in the “Appendix”) has any conflict of interest to declare. The study was not sponsored.

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Authors and Affiliations

  1. Department of Pediatric Sciences, University of Messina, 98123, Messina, Italy

    Fortunato Lombardo

  2. Department of Pediatrics, Azienda Ospedaliera, University of Milan, “Ospedale Luigi Sacco”, via G.B. Grassi 74, 20157, Milano, Italy

    Andrea E. Scaramuzza

  3. Department of Pediatrics, Second University of Naples, via S. Andrea delle Dame, 4, 80138, Naples, Italy

    Dario Iafusco

Authors
  1. Fortunato Lombardo
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  2. Andrea E. Scaramuzza
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  3. Dario Iafusco
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Corresponding author

Correspondence to Andrea E. Scaramuzza.

Additional information

This study is conducted for the Diabetes Study Group of the Italian Society of Paediatric Endocrinology and Diabetology (ISPED). All authors are listed in the “Appendix”.

Appendix

Appendix

R. Lera, Alessandria

V. Cherubini, Ancona

C. Zecchino, Department of Pediatrics, Bari

E. Frezza, Policlinico Giovanni XXIII, Bari

S. Zucchini, S. Salardi, Bologna

P. Frongia, Brotzu Hospital, Cagliari

D. Lo Presti, Catania

F. Citriniti, Catanzaro

S. Tumini, F. Chiarelli, Chieti

L. Spallino, Como

N. Lazzaro, Crotone

S. Toni, Firenze

G. d’Annunzio, R. Lorini, Genova

M. Bruzzese, Locri

F. Lombardo, G. Salzano, F. De Luca, Messina

R. Bonfanti, F. Meschi, San Rafael Institute, Milano

A. Scaramuzza, G. V. Zuccotti, University of Milano, Luigi Sacco Hospital, Milano

D. Iafusco, F. Prisco, Second University, Napoli

P. Buono, A. Franzese, Federico II University, Napoli

F. Cadario, Novara

V. Calcaterra, Pavia

L. Iughetti, Reggio Emilia

R. Schiaffini, M. Cappa, Bambin Gesù Hospital, Roma

M. Delvecchio, San Giovanni Rotondo

I. Rabbone, F. Cerutti, Torino

F. Fontana, Tortona

L. Guearraggio, Tradate

A. Salvatoni, Varese

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Lombardo, F., Scaramuzza, A.E. & Iafusco, D. Failure of glycated hemoglobin drop after continuous subcutaneous insulin infusion initiation may indicate patients who discontinue: a 4-year follow-up study in children and adolescents with type 1 diabetes. Acta Diabetol 49 (Suppl 1), 99–105 (2012). https://doi.org/10.1007/s00592-011-0344-3

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  • DOI: https://doi.org/10.1007/s00592-011-0344-3

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