The Management of Diabetes in Children

Table of Contents

The management of diabetes in children needs comprehensive understanding owing to the age of patients and the complexity that comes with the disease. The use of insulin pump therapy to manage diabetes in children has been gaining popularity over the last two decades. However, the effectiveness of this technique has been questioned, with one side pointing to the lack of long-term positive results when using this therapy. On the other hand, the proponents of this technique have argued that it is a revolutionary therapy that offers a better alternative to the common methods used to manage childhood diabetes. Therefore, the authors of this article sought to establish the long-term impacts of insulin pump therapy in the management of diabetes in children. One of the challenges with the available studies on the subject is that they have been conducted over short periods. Therefore, this study was carried out for seven years to address the aforementioned problem with the available literature.

Findings

The authors of this study established that insulin pump therapy reduces severe hypoglycemia significantly. In the study, Johnson, Cooper, Jones, and Davis (2013) found out that this therapy “reduced severe hypoglycemia from 14.7 to 7.2 events per 100 patients” (p. 2393). On the other hand, in control patients where this therapy was not used, severe hypoglycemia increased from 6.8 percent to 10.2 events per every 100 patient-years (Johnson et al., 2013). Similarly, the rate of hospitalization due to diabetic ketoacidosis (DKA) was lower in the pump cohort at 2.3 events in 100 patient-years as compared to the control cohort at 4.7 events per 100 patient-years. In total, 1,160 patients were used as participants in this study. For the control cohort, normal daily injections were used as the management mechanism for severe hypoglycemia in children.

Analysis of Insulin Pump Therapy

Also known as continuous subcutaneous insulin infusion (CSII), insulin pump therapy uses a wearable device called an insulin pump to provide a steady and continuous stream of insulin into the body of the user. The device is the size of a smartphone, and thus it is portable, and it can be easily concealed. A thin tube known as an infusion set is used to attach the device to the body.

The effectiveness of this therapy hinges on two principles. The first one is the basal rate, which is the minimum amount of insulin that the pump delivers to the body continuously (Deeb et al., 2015). The healthcare provider programs one’s basal rate depending on the body’s needs for insulin. In addition, the amount of insulin pumped through the device is precise, and it can be customized to deliver varying quantities at different times. Therefore, this device mimics a healthy human being’s pancreas closely. The second principle is known as the bolus dose (Deeb et al., 2015). The insulin pump can deliver additional insulin on demand based on body requirements. For instance, immediately after taking meals, blood sugar rises, and thus the pump is used to deliver insulin to regulate the levels of the same. Insulin pumps have inbuilt bolus calculators that determine the bolus amounts needed based on the body requirements. Therefore, given the dynamics of this pump, a diabetic user can lead a normal lifestyle.

The mechanism of operation of the insulin pump is simple and straightforward. The device has a compartment that carries a reservoir for insulin. This insulin travels from the reservoir to the body through the narrow tube connecting it with the infusion set. At the end of the infusion set is a cannula that is placed under the skin.

With reference to the result findings from the study, different reasons can be given as to why cohorts using insulin pump therapy experienced better results as compared to the control participants. First, as mentioned earlier, the pump delivers insulin to the body steadily and continuously, and thus the user may not experience sudden highs or lows of blood glucose levels. Additionally, the delivery of insulin is precise and accurate in the required amounts. This aspect may explain why there were fewer cases of hospitalizations associated with DKA among participants using the pump as compared to their counterparts using the normal injections. In addition, when using injections, it means that a patient needs around six daily injections. The numerous injections develop resistant areas where insulin is not absorbed properly (Patton, Driscoll, & Clements, 2017). On the other hand, users of the pump therapy may need only one injection after every three days for hook up. Therefore, the development of resistant areas will be minimal. A combination of the factors mentioned above explains the study’s findings where pump therapy reduced severe hypoglycemia and achieved reduced DKA-associated hospitalization cases.

Conclusion

The study by Johnson et al. (2013) established that pump therapy is a better diabetes management tool in children as compared to normal injections. The pump delivers insulin continuously to the body, thus avoiding sharp fluctuations of blood glucose. Additionally, users can customize the device to deliver differing bolus doses to cater to the changing body needs. As such, insulin pump therapy allows diabetic individuals to lead normal lives without the fear of having to suffer from sharp highs and lows of blood glucose.

References

Deeb, A., Abu-Awad, S., Abood, S., El-Abiary, M., Al-Jubeh, J., Yousef, H., … Mustafa, H. (2015). Important determinants of diabetes control in insulin pump therapy in patients with type 1 diabetes mellitus. Diabetes Technology and Therapeutics, 17(3), 166-170.

Johnson, S. R., Cooper, M. N., Jones, T. W., & Davis, E. A. (2013). Long-term outcome of insulin pump therapy in children with type 1 diabetes assessed in a large population-based case-control study. Diabetologia, 56(11), 2632-2400.

Patton, S. R., Driscoll, K. A., & Clements, M. A. (2017). Adherence to insulin pump behaviors in young children with type 1 diabetes mellitus. Journal of Diabetes Science and Technology, 11(1), 87-91.

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