Children with type 1 diabetes who initiate insulin pump use within six months of diagnosis have better outcomes than those who delay initiation until the second or third year after diagnosis, a recent study suggests. Researchers examined data on 8,332 youth diagnosed with type 1 diabetes between the ages of 6 months and 15 years (median age at diagnosis 6.1 years) and treated at one of 311 diabetes centers in Germany, Austria, Switzerland and Luxembourg from 2004 to 2014. The study included 4,004 youth who initiated insulin pump therapy within six months of diagnosis, and 4,328 youth who had delayed insulin pump initiation until the second or third year. After a median follow-up period of 6.7 years, the patients with earlier insulin pump initiation had lower mean HbA1c (7.9% and 62.6 mmol/mol) than those with delayed initiation (8.0% and 64.1 mmol/mol). Youth in the early-initiation group also had lower rates of hypoglycemic coma (incidence risk ratio 0.44) and hospitalization (IRR 0.86) than youth with delayed insulin pump initiation. "We already knew that an insulin pump could have a beneficial effect on diabetes outcomes, but the optimal time to start was not clear," said lead study author Dr. Clemens Kamrath of the division of pediatric endocrinology and diabetology at the Center of Child and Adolescent Medicine at Justus Liebig University in Giessen, Germany. The exact reason for the benefits of early insulin pump initiation aren't clear from the study, Dr. Kamrath said by email. "It could be that patients and parents benefit more from training if they start insulin pump therapy early," Dr. Kamrath said. "The diabetes team also takes more time for training immediately after diagnosis than later." There were also cardiovascular benefits associated with early insulin pump initiation, researchers report in The Lancet Child & Adolescent Health. Mean systolic blood pressure in the early-initiation group was lower than with delayed initiation (117.6 mmHg vs 118.5 mmHg). Mean HDL cholesterol was higher in the early-initiation group than with delayed initiation (62.8 mg/dL vs 60.6 mg/dL). Diastolic blood pressure, however, wasn't significantly different between the groups, and neither was LDL cholesterol, non-HDL cholesterol, triglycerides or estimated body mass index standard deviation scores. One limitation of the study is that researchers lacked data on the indications for insulin pump initiation at the individual patient level, the study team notes. They also lacked the data to account for some factors that might influence health outcomes for these patients, such as socioeconomic status, and parental income and education levels. Even so, the results underscore the potential for early insulin pump initiation to benefit kids, said Dr. Simon Heller, a clinical professor of diabetes at the University of Sheffield in the UK who wasn't involved in the study. "I think this study demonstrates that pumps when used by engaged families can probably overcome at least in part the limitations of injected insulin therapy," Dr. Heller said by email. "Reductions in severe hypoglycemia, the main benefit, are really worthwhile, particularly in the youngest children whose developing brains are most at risk of repeated hypoglycemia." —Lisa Rapaport Source
