Kids with the highest blood-sugar levels experienced the most improvement after starting insulin pump treatment, according to new research from BC Children’s Hospital and the University of British Columbia (UBC). The study, published in print today in Pediatric Diabetes, suggests insulin pump therapy should be considered for children with higher blood sugar levels to help avert some of the lifelong complications of diabetes.
“Guidelines for insulin pump therapy differ across Canada, but many suggest that, to be eligible, a child’s average blood sugar level should be below a certain threshold,” said Dr. Brenden Hursh, pediatric endocrinologist and investigator at BC Children’s, Clinical Assistant Professor in the UBC Department of Pediatrics and the study’s lead author.
“These criteria may have left many health-care providers with the impression that children with higher blood sugar levels will not benefit from insulin pump therapy. But our findings indicate that these children may actually improve the most.”
These new findings suggest clinicians may need to rethink which children are offered this treatment.
“Over 2,000 children in British Columbia live with type 1 diabetes and the technology used to manage the condition is changing rapidly,” said Dr. Hursh. “As insulin pump use becomes more common for children with diabetes, this study sheds light on which children may see the most improvement in diabetes management, and challenges our assumptions about who may be successful with a pump.”
One of those children is Kaden Miller. Kaden was 20 months old when he was diagnosed at BC Children’s with Type 1 Diabetes in 2014. Within a year, he was provided an insulin pump.
“The new technologies that are available to help kids like Kaden manage their diabetes are life-changing,” said Erin Miller, Kaden’s mother. “Although Kaden handled needles well for a boy his age, the freedom and control that an insulin pump gave our family was an enormous relief. He is now six years old and is already beginning to do his own blood checks with the pump himself. We hope more families are able to find the best treatment plan that work for them.”
To keep their blood sugar levels within the recommended range, kids with diabetes must inject themselves with insulin multiple times a day, frequently monitor their blood sugar and carefully manage their diet and exercise levels. Insulin pumps are portable devices that continuously deliver insulin through a small tube under the skin, which spares patients from the pain and hassle of insulin injections throughout the day. However, insulin pumps also have their drawbacks: they must be worn at all times and require frequent blood glucose testing and interaction by the child or parent.
“Part of our job as clinicians is to help children with diabetes and their families determine which treatment plan is best,” says Dr. Hursh. “We hope these findings can better inform discussions between patients and their doctors so that a broader range of children can consider if insulin pump treatment could work for them.”
- The study tracked 125 children with type 1 diabetes who started insulin pump therapy at BC Children’s from January 2011 through to June 2016.
- Blood sugar levels are tested using the hemoglobin A1c (HbA1c) test, which measures the average amount of blood sugar attached to red blood cells over the past three months. The ideal level for children with diabetes is less than 7.5 per cent; many children do not reach this target.
- Children were put into groups based on their pre-pump blood sugar levels into either “good” (HbA1c scores of less than 7.5 per cent), “moderate” (7.5 to 9 per cent) or “poor” (above 9 per cent) categories.
- Following insulin pump treatment blood sugar levels dropped in the “good” and “moderate” groups by 0.14 per cent and 0.54 per cent respectively, but the greatest improvement was in the “poor” category, which saw a reduction in HbA1c score of 1.08 per cent.
- Large-scale studies have shown that having a lower HbA1c reduces the risk of diabetes-related eye, kidney, nerve and heart disease.
- If not managed effectively, children with type 1 diabetes are at risk for serious health problems later in life such as kidney failure, blindness, nerve damage, and heart disease.
- A decrease of 1% in A1c, as was seen in the poor control group after they started pump therapy, is a significant step towards improved short and long-term health for a child with diabetes.
Further studies are needed to better understand precisely which children within the high A1c group have the most likelihood of success with pump therapy.
In British Columbia, the Pharmacare criteria for receiving an initial insulin pump does not restrict anyone with high A1c.