Characterization of metabolic responders on CSII treatment amongst children and adolescents in Denmark from 2007 to 2013

•463 children and adolescents with type 1 diabetes were followed prospectively for 24 months after initiation of CSII therapy.•Definition of metabolic response: a decrease in HbA1c ≥ 1% or obtaining HbA1c < 7.5%.•Only 32% were defined as responders after 24 months.•Young age and either high or low HbA1c at initiation predicted the outcome.•The most important factor for good metabolic control when on the pump is taking frequent boluses.

AimThis prospective study aimed to identify and estimate the frequency of responders offered Continuous subcutaneous insulin infusion (CSII) from baseline data and during follow-up, and secondly to characterize CSII users with good adherence to pump therapy among 463 children and adolescents with Type 1 diabetes mellitus.MethodsA response was defined as lowering HbA1c with 1% or achieving an HbA1c < 7.5% (58 mmol/mol). Good adherence was defined as measuring ≥7 self monitored blood glucoses (SMBGs) and taking ≥7 boluses daily. Logistic regression was used to estimate the effect of demographic and clinical variables prior to and during pump treatment.ResultsAt 24 months follow-up 32% qualified as responders. Stratifying for age at onset, 45% of the children aged <6 yrs qualified as responders vs. 32% and 28% of the youngsters and adolescents aged 6-12 yrs. and 12-19 yrs., respectively (p = 0.02). Responders were characterized by their HbA1c-level at pump onset (p = 0.001), taking more daily boluses (7.64 ± 3.33 vs. 6.40 ± 3.18 p = 0.003) and measuring more SMBGs per day at follow-up (6.88 ± 2.35 vs. 6.31 ± 2.54 p = 0.03). The incidence of severe hypoglycemia decreased from 14.3 to 3.3 events per 100 person years (p < 0.0001). Twenty percent did not respond despite a good adherence toward CSII therapy.ConclusionAge <6 years, high or low HbA1c at pump initiation and number of daily boluses were associated with improved or sustained near-normal metabolic outcome. The incidence of severe hypoglycemia was significantly reduced. Twenty percent of the population had good adherence without any metabolic improvement.