Insulin pump therapy, pre-pump hemoglobin A 1c and metabolic improvement in children with type 1 diabetes at a tertiary Canadian children's hospital
Insulin pump therapy, pre-pump hemoglobin A 1c and metabolic improvement in children with type 1 diabetes at a tertiary Canadian children's hospital
Background and Objectives
Indications for insulin pump therapy (IPT) in children with type 1 diabetes (T1D) are relatively non-specific and therefore subject to provider discretion. Health professionals' perceptions of which people will have difficulty with IPT, for example, those with higher hemoglobin A1c (HbA1c), may not be correct. This study examined the effect of IPT on HbA1c, and the role of pre-pump HbA1c on this effect.
Methods
All children with T1D started on IPT at British Columbia Children's Hospital from January 2011 through June 2016 were included if they had HbA1c values available both before and after IPT (n = 125). Generalized estimating equations was used to estimate the effects of IPT on HbA1c, stratified by pre-pump HbA1c levels (good: <7.5% [<58 mmol/mol], moderate: 7.5%-9.0% [58-75 mmol/mol], poor: >9.0% [>75 mmol/mol]).
Results
After adjusting for potential confounders, mean HbA1c decreased by 0.48% [5.2 mmol/mol] (95% confidence interval: −0.64, −0.33% [−7.0, −3.6 mmol/mol]; P < 0.0001) after IPT initiation. The adjusted mean HbA1c decreased by 0.14% [1.5 mmol/mol] (−0.35, 0.07% [−3.8, 0.8 mmol/mol]; P = 0.188), 0.54% [5.9 mmol/mol] (−0.74, −0.34% [−8.1, −3.7 mmol/mol]; P < 0.0001), and 1.08% [11.8 mmol/mol] (−1.69, −0.46% [−18.5, −5.0 mmol/mol]; P = 0.0006) after pump initiation in the good, moderate, and poor pre-pump metabolic control groups, respectively.
Conclusions
Pre-pump HbA1c appears to play a significant role in the effects of IPT on HbA1c, with the largest decrease in HbA1c seen in the poor pre-pump HbA1c group. Eligibility and consideration for IPT should be expanded to routinely include these children.
427-433
Botros, Sandra
158d6b90-f333-48c4-be0e-c03855f7a9c3
Islam, Nazrul
e5345196-7479-438f-b4f6-c372d2135586
Hursh, Brenden
bdceadb7-e4b5-4a44-abfa-55ec2b73118b
9 May 2019
Botros, Sandra
158d6b90-f333-48c4-be0e-c03855f7a9c3
Islam, Nazrul
e5345196-7479-438f-b4f6-c372d2135586
Hursh, Brenden
bdceadb7-e4b5-4a44-abfa-55ec2b73118b
Botros, Sandra, Islam, Nazrul and Hursh, Brenden
(2019)
Insulin pump therapy, pre-pump hemoglobin A 1c and metabolic improvement in children with type 1 diabetes at a tertiary Canadian children's hospital.
Pediatric Diabetes, 20 (4), .
(doi:10.1111/pedi.12834).
Abstract
Background and Objectives
Indications for insulin pump therapy (IPT) in children with type 1 diabetes (T1D) are relatively non-specific and therefore subject to provider discretion. Health professionals' perceptions of which people will have difficulty with IPT, for example, those with higher hemoglobin A1c (HbA1c), may not be correct. This study examined the effect of IPT on HbA1c, and the role of pre-pump HbA1c on this effect.
Methods
All children with T1D started on IPT at British Columbia Children's Hospital from January 2011 through June 2016 were included if they had HbA1c values available both before and after IPT (n = 125). Generalized estimating equations was used to estimate the effects of IPT on HbA1c, stratified by pre-pump HbA1c levels (good: <7.5% [<58 mmol/mol], moderate: 7.5%-9.0% [58-75 mmol/mol], poor: >9.0% [>75 mmol/mol]).
Results
After adjusting for potential confounders, mean HbA1c decreased by 0.48% [5.2 mmol/mol] (95% confidence interval: −0.64, −0.33% [−7.0, −3.6 mmol/mol]; P < 0.0001) after IPT initiation. The adjusted mean HbA1c decreased by 0.14% [1.5 mmol/mol] (−0.35, 0.07% [−3.8, 0.8 mmol/mol]; P = 0.188), 0.54% [5.9 mmol/mol] (−0.74, −0.34% [−8.1, −3.7 mmol/mol]; P < 0.0001), and 1.08% [11.8 mmol/mol] (−1.69, −0.46% [−18.5, −5.0 mmol/mol]; P = 0.0006) after pump initiation in the good, moderate, and poor pre-pump metabolic control groups, respectively.
Conclusions
Pre-pump HbA1c appears to play a significant role in the effects of IPT on HbA1c, with the largest decrease in HbA1c seen in the poor pre-pump HbA1c group. Eligibility and consideration for IPT should be expanded to routinely include these children.
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e-pub ahead of print date: 1 April 2019
Published date: 9 May 2019
Identifiers
Local EPrints ID: 471722
URI: http://eprints.soton.ac.uk/id/eprint/471722
ISSN: 1399-543X
PURE UUID: c9759161-488d-4c2c-8c4d-3b271f4ebefd
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Date deposited: 17 Nov 2022 17:32
Last modified: 17 Mar 2024 04:15
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Author:
Sandra Botros
Author:
Nazrul Islam
Author:
Brenden Hursh
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