Use of integrated real-time continuous glucose monitoring/insulin pump system in children and adolescents with type 1 diabetes : a 3-year follow-up study

Background: Insulin pumps and real-time continuous glucose monitoring devices have recently been combined into the sensor-augmented pump (SAP) system. The objective of this study was the evaluation of the clinical use of SAP in a large series of children with type 1 diabetes using insulin pump therapy. Methods: A questionnaire was administered in all pediatric diabetologic centers in Italy; data were analyzed only regarding patients 18 years old or younger and using SAP for 6 months or more. Results: Among all patients using an insulin pump, 129 (13.5 +/- 3.8 years old, with a disease duration of 6.3 +/- 3.4 years) have been using SAP for 1.4 +/- 0.7 years. Four hundred ninety-three patients (12.9 +/- 3.4 years old, with a disease duration of 6.2 +/- 3.3 years) using conventional insulin pump therapy for 1.7 +/- 0.5 years have been evaluated as the control group. After 0.5-3 years of using SAP or conventional insulin pump therapy, glycosylated hemoglobin significantly improved (8.0 +/- 1.5% vs. 7.4 +/- 0.8% [P = 0.002] and 8.0 +/- 1.6% vs. 7.7 +/- 1.1% [P = 0.006], respectively); the improvement was higher with SAP (P = 0.005). Insulin requirement showed a significant decrease only in SAP patients (0.88 +/- 0.25 vs. 0.7 +/- 0.23 U/kg/day, P = 0.003). Body mass index did not change during the observation period. No diabetic ketoacidosis episodes were observed during the follow-up, and severe hypoglycemia significantly decreased in SAP patients (P = 0.04). Conclusions: The increased availability of continuous glucose sensors is likely to have a significant impact on pediatric diabetes therapy and education in the near future. In daily settings, patients using SAP can achieve a better control than patients using conventional insulin pump