Poor adherence to integral daily tasks limits the efficacy of CSII in youth

Authors

  • MA O'Connell,

    Corresponding author
    1. Department of Endocrinology and Diabetes, The Royal Children's Hospital and Murdoch Children's Research Institute, Melbourne, Australia
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  • S Donath,

    1. Clinical Epidemiology and Biostatistics Unit, The Royal Children's Hospital and Murdoch Children's Research Institute, Melbourne, Australia
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  • FJ Cameron

    1. Department of Endocrinology and Diabetes, The Royal Children's Hospital and Murdoch Children's Research Institute, Melbourne, Australia
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Dr Michele O'Connell, Department of Endocrinology & Diabetes, Royal Children's Hospital, Parkville, Victoria 3052, Australia.
Tel: +61 3 93455951;
fax: +61 3 93477763;
e-mail: michele.oconnell@rch.org.au

Abstract

O'Connell MA, Donath S, Cameron FJ. Poor adherence to integral daily tasks limits the efficacy of CSII in youth.

Introduction/Aims: Many young people experience improved glycemia with continuous subcutaneous insulin infusion (CSII) regimens; however, sustained glycemic benefit eludes a significant proportion. Our aims were to assess adherence to recommended CSII-related behaviors in a representative pediatric cohort and to identify potentially modifiable behaviors that impact on HbA1c in youth.

Research Design and Methods: Data uploaded from insulin pump devices of 100 youth with type 1 diabetes were analyzed.

Results: Ability to translate recommended behaviors into daily self-management varied widely in youth. Mean bolus frequency was 6.1/d; however, 69/100 entered <4 blood glucose levels (BGL)/d. HbA1c decreased by 0.2% for each additional BGL (p = 0.001) and bolus event (p < 0.001) per day. Prandial insulin omission was common and associated with significantly increased HbA1c. On average, if breakfast insulin was missed ≥4 times per fortnight, HbA1c increased 1.0% (p < 0.001). If one or more days per fortnight with ≤2 food boluses/d were recorded, then HbA1c increased 0.8% (p = 0.001). Increasing age and duration of CSII correlated with poorer adherence to recommended behaviors.

Conclusions: Glycemic advantage obtained with CSII regimens is closely related to the manner in which CSII is employed. Poor adherence to integral CSII-related tasks is frequently encountered in adolescents and limits the efficacy of CSII in these youth.

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