Abstract 491 Endocrinology & Diabetes III Platform, Sunday, 5/2

While the DCCT recommended that patients with type 1 diabetes should be treated with either multiple daily injections (MDI) or insulin pump therapy (CSII) to attain near-normal metabolic control, many clinicians have been reluctant to use CSII in adolescents. We have been conducting a prospective clinical trial of ways to achieve metabolic control equivalent to that in the adolescents in the DCCT. 75 adolescents (age 14±2 y, diabetes duration 9±4 y) enrolled in the study have completed 12 months of follow-up. All received intensive management similar to the DCCT including the option to self-select CSII or MDI. The teens who chose CSII (n=25) were similar in baseline clinical characteristics and psychosocial variables as those choosing MDI (n=50). Clinical data (HbA1c, height, weight, hypoglycemic events) were collected monthly and diabetes quality of life and coping self-report questionnaires were completed every 6 months. (Table) As shown above, HbA1c levels were reduced in both groups with mean levels in our CSII patients substantially lower that target DCCT values (∼8.1%). Despite lower HbA1c levels, rates of severe hypoglycemic events were almost 50% less with CSII vs. MDI and there was no significant difference in episodes of DKA between the two groups. CSII-treated adolescents also found diabetes easier to cope with than MDI patients on self-reported questionnaires (p <.03). As more clinicians aim to implement intensive therapy in adolescents with diabetes, CSII should be considered as a means to achieve strict control of diabetes and reduce the risk of hypoglycemia without compromising psychosocial outcomes.

Table 1 No caption available.
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