LAUSR

Aim Insulin pump therapy i.e. Continuous Subcutaneous Insulin Infusion therapy (CSII) is a well-recognised treatment modality in Type 1 Diabetes Mellitus (T1DM). NICE recommends a target%HbA1c level ≤6.5% to minimise long-term complication risk1. CSII can be considered in patients<12 years and in those whose%HbA1c have remained high (≥8.5%) on multiple daily insulin therapy despite a high level of care.1 The aim of this audit is to review diabetes control over time in T1DM patients managed with CSII in our Paediatric Diabetes Unit (PDU). Methods Retrospective review of diabetes control (%HbA1c) of TIDM patients managed with CSII in our PDU (23/03/2009–10/01/2017). Inclusion criteria=All patients managed with CSII whose data is complete i.e. have a locally recorded pre-CSII%HbA1c and are managed with CSII for at least one full year following switch to CSII. Pre-CSII%HbA1c=mean of up to three%HbA1c recorded prior to switch to CSII. Annual CSII%HbA1c=mean of all%HbA1c recorded per whole year since switching to CSII. Results In the time period reviewed there have been a total of 57 patients managed with CSII; seven patients were excluded from analysis. There was a slight male preponderance (1.08:1, 52%) with a mean age (±SD) at diagnosis/transfer into our unit of 7.6 years (±4.5 years) and at switch to CSII of 10.2 years (±4.8 years). Analysis of data showed that those patients with the better control pre-switch generally maintained better control following switch to CSII. Despite the fact that annual%HbA1c showed that diabetes control generally worsens over time, cohort annual%HbA1c have remained relatively stable over the seven-year study period. Conclusion Our PDU has a small number of patients managed with CSII. Results obtained were reflective of other studies which demonstrated worsening diabetes control over time2. Despite this, cohort annual results have remained relatively stable. The difficulties of managing patients as they transition through puberty into adolescence/adulthood are well recognised. Supportive and educational opportunities must be maximised for optimal diabetes control and prevention of complications.