Continuous subcutaneous insulin infusion (CSII) and intensive instruction with a rule-set-system program (RSSP) without continuous glucose measuring (CGMS) markedly improves glucose control and quality of life among children with type-1-diabetes (T1D) compared with a multiple injection therapy (MIT) of “good quality”

Objective:

The benefit of near normal HbA1c to prevent and retard late complications has definitely proofed in the DCCT/EDIC⁴ studies, particular important for the potential long life expectancy of paediatric patients. But what about the risks of severe hypoglycemia, the efforts and their quality of life?

Methods:

We compared intra-individually HbA_1c, frequency of hypoglycemia, quality of life before and after switch from MIT to CSII in 73 children with T1D (> 1,5 years, < 16 years). They first were trained individually and cared for at least 1 year with MIT by a paediatric diabetologist. Switching on pump they and their parents underwent an 18 day RSSP⁵. At defined times we collected somatic and psychosocial data from valided questionnaires⁶.

Results:

HbA_1c declined from 7.4% to 6.7% (lost of- 0.19% -1.31%; p = 0.0114). Severe hypoglycemia (external help, unconsciousness, seizures) nearly halved (p = 0.021). Parents generally high expectations of CSII were usually met (very) well. Patients satisfaction and treatment compliance with CSII is significantly higher, also childrens quality of life and families burden developed positively 1 year almost in all criteria.

Conclusion:

Similiar to the results of our retrospective study of 1136 grown-ups⁷, also children with T1D with above-averaged HbA_1c improve all important outcomes when switched from MIT to CSII following instructions of RSSP, even if inconstantly executed by patients. Can RSSP-training without CGMS produces even better results than a hybrid-closed-loop therapy, just published⁸? Therefore we have condensed RSSP in a continuously advising App (AdviceDevice), as announced at EASD 2005⁹.

^4,5,6,7,8,9 Literature shown in the original.