Abstract
Continuous subcutaneous insulin infusion (CSII) pump therapy was introduced to treat patients with type 1 diabetes (T1DM) more than 20 years ago1,2. At that time, most children and adolescents were being treated with one or two daily injections of mixtures of NPH and regular insulin of animal origin and treatment was adjusted based on urinary glucose excretion. With these inadequate methods, it’s not surprising that glucose levels often averaged over 300 mg/dl and that the children were at high risk for the later development of the devastating complications of diabetes. CSII offered the opportunity to more closely simulate the patterns of plasma insulin levels seen in normal children. The more predictable pharmacokinetics of fast-acting versus intermediate-acting insulin3 and the administration of bolus doses immediately prior to each meal were two obvious advantages of this approach to insulin replacement. The development of newer, smaller pumps with variable basal rate profiles allowed for a closer match in insulin needs, particularly overnight, leading to a reduction in nocturnal hypoglycemia.
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References
Tamborlane WV, Sherwin RS, Genel M, Felig P. Reduction to normal of plasma glucose in juvenile diabetics by subcutaneous administration of insulin with a portable infusion pump. N Engl J Med 1979; 300:578.
Pickup JC, Keen H, Parsons JA, Alberti KGMM. Continuous subcutaneous insulin infusion: an approach to achieving normoglycemia. Br Med J 1978; 1:204–207.
Lauritzen T, Pramming S, Deckert T, Binder C. Pharmacokinetics of continuous subcutaneous insulin infusion. Diabetologia 1983; 24:326–329.
DCCT Research Group. The effects of intensive diabetes treatment on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial. N Engl J Med 1993; 329:977–986.
The DCCT Research Group. The effect of intensive diabetes treatment on the development and progression of long-term complications in adolescents with insulin-dependent diabetes mellitus: the Diabetes Control and Complications Trial. J Pediatr 1994; 125:177–188.
DCCT/EDIC Research Group. Prolonged beneficial effects of intensive therapy of diabetes during adolescence: microvascular outcomes four years after conclusion of the Diabetes Control and Complications Trial. J Pediatr 2001; 139: 804–812
DCCT Research Group. Resource utilization and costs of care in the Diabetes Control and Complications Trial. Diabetes Care 1995; 18:1468–1478.
Boland EA, Grey M, Fredrickson L, Tamborlane WV. CSII: a “new” way to achieve strict metabolic control, decrease severe hypoglycemia and enhance coping in adolescents with type I diabetes. Diabetes Care 1999; 22:1779–1894.
Zinman B, Tildesley H, Chiasson TJ, Tsue E, Strack T. Insulin lispro in CSII: results of a double-blind crossover study. Diabetes 1997; 46:440–443.
Howey DC, Bowsher RR, Brunelle RL, Woodworth JR. [Lys(B28),Pro(B29)]-human insulin. A rapidly absorbed analogue of human insulin. Diabetes 1994; 43:396–402.
Ahem JH, Boland EA, Doane R, Vincent M, Tamborlane WV. Insulin pump therapy in pediatrics: a therapeutic alternative to safely lower therapy HbA1c levels across all age groups. Pediatric Diabetes, in press
deBeaufort CE, Houtzager CMGJ, Bruining GJ et al: Continuous Subcutaneous Insulin Infusion (CSII) Versus Conventional Injection Therapy in Newly Diagnosed Diabetic Children: Two-year Follow-up of a Randomized, Prospective Trial. Diabetic Medicine, 6:766–71, 1989
Tubiana-Rufi N, deLonlay P, Block J, Czemichow P. Remission of severe hypoglycemia incidents in young diabetic children treated with subcutaneous infusion. Arch Pediatr 1996; 3:969–976.
Buckingham BA, Paguntalan H, Fassl B, Wilson DM. Continuous subcutaneous infusio (CSII) in children under five years of age. Diabetes 2001; 50 (Suppl. 2): A107.
Maniatis AK, Klingensmith GJ, Slover RH, Mowry CJ, Chase HP. Continuous subcutaneous insulin infusion therapy for children and adolescents: an option for routine diabetes care. Pediatrics 2002; 107:351–356.
White NH, Hollander AS, Sadler M, Daniels L. Risks and benefits of continuous subcutaneous insulin infusion (CSII) therapy in children. Diabetes 2001; 50 (Suppl. 2):A66
Celona-Jacobs N, Weinzimer SA, Rearson M, Hartz D, Katz L, Murphy K. Insulin pump therapy in children: a cautionary tale. Diabetes 2001; 50 (Suppl. 2): A67.
Laffel L, Loughlin C, Ramchandani N, Butler D, Laffel N, Levine B-S, Anderson B. Glycemic challenges of pump therapy (CSII) in youth with type 1 diabetes (T1DM). Diabetes 2001; 50 (Suppl.2):A66.
Kaufman FR, Kim C, Halvorson M, Pitukcheewanont P. Use of insulin pump therapy at nighttime only for children 7-10 years of age with type 1 diabetes. Diabetes Care 2000; 23:579–582.
Boland EA. Teens Pumping it Up, 2nd Edition. Sylmar, CA:MiniMed, 1998.
Kaufman FR, Halvorson M, Miller D, Mackenzie M, Fisher, LK, Pitukcheewanont P. Insulin pump therapy in type 1 pediatric patients: now and into the year 2000. Diabetes Metab Res Rev 1999; 15:338–352.
Ahern JA, Ramchandani N, Cooper J, Himmel A, Silver D, Tamborlane WV. Using a primary nurse manager to implement DCCT recommendations in a large pediatric program. The Diabetes Educator 2000; 26:990–994.
Grey M, Boland EA, Davidson M, Li J, Tamborlane W. Coping skills training for youth on intensive therapy has long lasting effects on metabolic control and quality of life. J Pediatr 2000; 137:107–114.
Griffin ME, Feder A, Tamborlane WV. Lipoatrophy associated with lispro insulin in insulin pump therapy: an old complication, a new cause? Diabetes Care 24:174, 2001.
Attia N, Jones TW, Holcombe J, Tamborlane WV. Comparison of human regular insulin and lispro insulin after interruption of CSII and in the treatment of acutely decompensated IDDM. Diabetes Care 1998; 21:817–821.
Boland EA, Monsod T, DeLucia M, Brandt C, Fernando S, Tamborlane WV. Limitations of conventional methods of self monitoring of blood glucose: lessons learned from three days of continuous glucose sensing in pediatric patients with type I diabetes. Diabetes Care 2001; 24
Kaufman FR, Gibson LC, Halvorson J, Carpenter S, Fisher LK, Pitukcheewanont P. A pilot study of the continuous glucose monitoring system: clinical decisions and glycemic control after its use in pediatric type 1 diabetic subjects. Diabetes Care 2001; 24:2030–34.
Albisser M, Leibel BS, Ewart TG, et al. Clinical control of diabetes by the artificial pancreas. Diabetes 1974; 23:397–404.
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Ahern, J.A.H., Boland, E.A., Tamborlane, W.V. (2003). Insulin Pump Therapy. In: Menon, R.K., Sperling, M.A. (eds) Pediatric Diabetes. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-0507-5_12
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DOI: https://doi.org/10.1007/978-1-4615-0507-5_12
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