Missed insulin meal boluses and elevated hemoglobin A1c levels in children receiving insulin pump therapy.
OBJECTIVE: To identify possible causes of suboptimal glycemic control (ascertained by hemoglobin A1c [HbA1c] level) in youths using insulin pump therapy.
METHODS: Forty-eight youths who were receiving insulin pump therapy for > or =6 months, and who were using insulin pumps and blood glucose meters with data that could be downloaded at our facility, are included in this cross-sectional study. Possible causes of suboptimal glycemic control were evaluated by using 4 information sources: 1) insulin pump data downloads; 2) glucose meter data downloads; 3) patient/family questionnaire about insulin bolusing habits, eating habits, exercise, and blood glucose testing habits; and 4) a physician questionnaire. Physicians completed the questionnaire during the patient interview after reviewing the downloaded information and discussing these results with the patient/family.
RESULTS: The mean (+/- standard deviation) age of participants was 15.3 (+/-3.0) years (range: 7-20 years), and the mean (+/- standard deviation) duration of type 1 diabetes and continuous subcutaneous insulin infusion was 8.2 (+/-4.0) and 1.9 (+/-1.0) years, respectively. Patients who missed(95% confidence interval) HbA1c level of 8.0% (7.7, 8.3), whereas those who missed > or =1 mealtime boluses per week had a mean HbA1c level (95% confidence interval) of 8.8% (8.6, 9.1). No significant relationships were found between HbA1c levels in males and females, the amount of exercise per week, or bolusing before insulin pump disconnection for exercise. Although not significant, a trend was found for those who missed(r =.414) and mean blood glucose levels (r =.70).
CONCLUSION: Missed mealtime insulin boluses seem to be the major cause of suboptimal glycemic control in youths with diabetes receiving continuous subcutaneous insulin infusion therapy.
Medical Subject Headings
Adolescent; Blood Glucose; Child; Cross-Sectional Studies; Diabetes Mellitus, Type 1; Female; Glycated Hemoglobin A; Humans; Insulin; Insulin Infusion Systems; Male
3 Pt 1
Digital Object Identifier (DOI)
Burdick, Jonathan; Chase, H Peter; Slover, Robert H; Knievel, Kerry; Scrimgeour, Laura; Maniatis, Aristides K; and Klingensmith, Georgeanna J, "Missed insulin meal boluses and elevated hemoglobin A1c levels in children receiving insulin pump therapy." (2004). Neurology. 328.