Continuous subcutaneous insulin infusion in preschool children with type 1 diabetes mellitus as initial treatment: Effect on glycemic control

Background: Diabetes management and achieving good glycemic control are challenging in preschool period. Continuous subcutaneous insulin infusion (CSII) is the treatment of choice for managing type 1 diabetes mellitus (T1DM), especially in children under seven years of age. Objective: To compare the glycemic control (HbA1c), anthropometric measurements, daily insulin requirement and basal and bolus insulin rates of the group using CSII as initial therapy with the group using multiple initial daily injection (MDI) treatment. Method: Ten children with T1DM using CSII as a first-line therapy, who were followed up regularly for at least 1 year, and 10 children using MDI, who were similar in terms of age and gender with CSII group, were included in this retrospective study. Daily total insulin (U/kg), basal and bolus insulin rates, and HbA1c values of the children, obtained from medical records, were compared during the first year of the follow-up. Results: The mean age of diagnosis of children with T1DM was 2.01 +/- 1.28 years in the CSII group and 3.11 +/- 1.49 years in the MDI group. While HbA1c values measured in the first year showed a significant decrease in both treatment groups, first year HbA1c was significantly lower in the CSII group compared to the MDI group (p=0.04). Mean total daily insulin requirement for first year was 0.61 +/- 0.10 U/kg in the CSII group, and 0.82 +/- 0.18 U/kg in MDI (p=0.007). Conclusion: in children under the age of 5 with T1DM, using CSII as initial therapy provided better metabolic control with a lower daily insulin dose than MDI regimen even in the first year of the treatment. Studies with longer duration and more participants are needed