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• W66332511 abstract "It is well established that insulin pump therapy [continuous subcutaneous insulin infusion (CSII)] has several advantages when compared with multiple daily injections (MDI) of insulin, especially the sensor-augmented pump.1 However, we do not know whether the improvement in technology is accompanied by a high or low frequency of pump breakdowns or pump malfunctions (PM) and whether this has an impact on metabolic control.During a survey, we extrapolated the answers concerning malfunctions of the pump itself or the infusion set. Patients were divided into two groups according to the presence or absence of PM. Age, disease duration, last glycated hemoglobin (HbA1c), mean HbA1c of the whole period using CSII, last insulin requirement, last body mass index z-score, and severe hypoglycemia and diabetic ketoacidosis were compared in the two groups of children with type 1 diabetes.The use of a bolus calculator, the number of boluses made with the bolus calculator, the use of different type of boluses, the use of temporary basal, and the number of self-monitoring of blood glucose were also evaluated.The primary end point was the change in HbA1c between patients with or without PM.Among the 280 patients at our center, 130 (46%) were using CSII, of which 41 (32%) had used it for 3 years or more (range, 3–8.7 years; mean ± standard deviation, 5.3 ± 1.5 years). Pump malfunctions were recorded in 19/41 patients (46.3%), including battery or drive mechanism failure (n = 9, 47.4%), pump breakdown (n = 4, 21%), or others, including one theft (n = 6, 32.7%).Interestingly, after analyzing data of the two groups (malfunction or not), we found a significantly higher HbA1c in the malfunction group, while no difference was observed for any other factor analyzed (Table 1). In addition, in the group without PM, there were significantly more patients with HbA1c < 7.5% (58 mmol/mol; International Society for Pediatric and Adolescent Diabetes recommendations) than those who had had PM (50% versus 21%; p = .004 by chi-square test). Moreover, although various types of infusion set defects have been reported in 27/41 patients (65.9%), this does not seem to affect glycemic control, neither at the last visit or as a mean of the whole period using CSII (p = .75 and p = .56, respectively).Table 1Clinical Characteristics of the 41 Children with Type 1 Diabetes Using an Insulin Pump for More Than 3 Years, According to Pump Malfunction (n = 19) or Not (n = 22)aThe high number of pump and set failures, similar to that reported elsewhere,2–4 did not affect the increase of acute complications, probably because current insulin pumps already incorporate systems to detect some types of fault.To the best of our knowledge, no one has investigated the possible relationship between PM and impairment in metabolic control, as observed here. In our opinion, it is not a problem due to an acute lack of insulin, the breakdown of the insulin pump, or the delay in patients’ support (in Italy, pump companies offer a 24/7 assistance service, and in each case, the replacement of the pump occurred in less than 36 h and patients were instructed to use MDI in the meantime), but rather a possible distrust of the machine. It is as if the patients who experienced PM have a lesser confidence in the instrument and its technology.Ours is just a pilot (and in some way not planned) experience that needs to be confirmed in larger groups of patients. In the meantime, this aspect should be a warning for companies that make insulin pumps. Having a Ferrari (a smart pump) may be pointless if you are afraid of being left on foot.If anyone is interested, we are available to run a multicenter study about the relationship between PM and glycemic control." @default.
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• W66332511 date "2013-07-01" @default.
• W66332511 modified "2023-09-25" @default.
• W66332511 title "Insulin Pump Therapy in Children with Type 1 Diabetes: The Dark Side of the Moon" @default.
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• W66332511 doi "https://doi.org/10.1177/193229681300700435" @default.
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