Abstract

Background: Intensive insulin therapy is progressively replacing conventional therapy in young children to improve diabetes control. However, the specific skills required to manage insulin pumps may hamper social integration as much as the fear of severe hypoglycemia using conventional therapy. Methods: The impact of a continuous education program targeting parents and their substitutes on their living places, was assessed in 23 subjects aged 2.3 ± 0.2 years treated by insulin pump (CSII) for 3.2 ± 0.6 years and compared to 23 subjects aged 3.2 ± 0.2 years treated by conventional therapy (CV) for 3.5 ± 0.3 y. Results: HbA1c levels were undistinguishable in both groups throughout the study period, remaining within recommended ADA target. Whereas a greater increase in insulin dose was observed in the CV group (0.57 ± 0.06 to 0.79 ± 0.03 U/kg/day, p < 0.001) versus 0.64 ± 0.04 to 0.70 ± 0.04 U/kg/day (ns) in the CSII group over time, inter-group differences failed to reach significance. BMI SDS increased significantly in CSII group (p = 0.004). No significant difference was observed in the number of days of admission/subject and in the number of admissions for severe hypoglycemia. The number of admissions for ketoacidosis was higher in the CSII group (p = 0.027). Conclusions: Externalizing targeted education programs on the child living place allows to minimize the hypoglycemia risk of CV. This result may be particularly relevant for less developed countries and contribute to reduce the cost of diabetes management without increasing the risks of side effects.

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