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Pediatr Diabetes. 2011 Sep;12(6):556-9. doi: 10.1111/j.1399-5448.2010.00740.x. Epub 2011 Apr 6.

Poor adherence to integral daily tasks limits the efficacy of CSII in youth.

Author information

  • 1Department of Endocrinology and Diabetes, The Royal Children's Hospital and Murdoch Children's Research Institute, Melbourne, Australia. michele.oconnell@rch.org.au

Abstract

INTRODUCTION/AIMS:

Many young people experience improved glycemia with continuous subcutaneous insulin infusion (CSII) regimens; however, sustained glycemic benefit eludes a significant proportion. Our aims were to assess adherence to recommended CSII-related behaviors in a representative pediatric cohort and to identify potentially modifiable behaviors that impact on HbA1c in youth.

RESEARCH DESIGN AND METHODS:

Data uploaded from insulin pump devices of 100 youth with type 1 diabetes were analyzed.

RESULTS:

Ability to translate recommended behaviors into daily self-management varied widely in youth. Mean bolus frequency was 6.1/d; however, 69/100 entered <4 blood glucose levels (BGL)/d. HbA1c decreased by 0.2% for each additional BGL (p=0.001) and bolus event (p<0.001) per day. Prandial insulin omission was common and associated with significantly increased HbA1c. On average, if breakfast insulin was missed ≥4 times per fortnight, HbA1c increased 1.0% (p<0.001). If one or more days per fortnight with ≤2 food boluses/d were recorded, then HbA1c increased 0.8% (p=0.001). Increasing age and duration of CSII correlated with poorer adherence to recommended behaviors.

CONCLUSIONS:

Glycemic advantage obtained with CSII regimens is closely related to the manner in which CSII is employed. Poor adherence to integral CSII-related tasks is frequently encountered in adolescents and limits the efficacy of CSII in these youth.

© 2011 John Wiley & Sons A/S.

PMID:
21466646
[PubMed - indexed for MEDLINE]
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