Embedding CSII therapy in the routine management of diabetes in children: a clinical audit of this service in Leeds

The aim of this study was to document the clinical and secondary care cost benefit of continuous subcutaneous insulin infusion (CSII) over a five-year period in the Leeds Paediatric Diabetes Service. Patients with type 1 diabetes treated using CSII therapy since 2002 who attended the paediatric diabetes clinics in Leeds, UK, were eligible for inclusion. Information on glycaemic control (HbA1c) and frequency/type of hospital admission was collected during the 12-month period before CSII was initiated and compared prospectively after the transition to pump therapy. Multi-level regression modelling was used to assess the change in HbA1c levels and the effect of patient characteristics. Data were included on 84 individuals ranging in age from 0 to 18 years, 54% of whom were female. Mean (SD) HbA1c levels improved from a baseline of 9.4 ± 1.7% to 8.9 ± 1.5%, with a significant overall reduction of 0.53% within the first year (95% CI 0.29-0.78%). The improvement in HbA1c levels was sustained for up to five years after CSII therapy commenced. Regression modelling showed that age, sex and duration of diabetes were not significantly associated with change in HbA1c levels. Hospital admission rates fell for severe hypoglycaemia from 8.9 to 2.4 per 100 patient years although hyperglycaemia admissions remained largely the same (7.6 vs 7.3 on CSII per 100 patient years). We concluded that patients treated using CSII appear to exhibit both improved glycaemic control, which is sustained over the short/medium term, and lower hospital admission rates for hypoglycaemia. Copyright © 2009 John Wiley & Sons.