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By Lynda Williams, medwireNews Reporter

medwireNews: For children with type 1 diabetes who are admitted to hospital, continuing with a home insulin pump is feasible for the prevention of hyperglycemia and hypoglycemia, suggests research published in JAMA Network Open.

“These findings suggest that home insulin pump use is safe among children admitted to a children’s hospital, and home insulin pump use should be considered in most non-intensive care unit admissions”, advise Sarah Lawson, from Cincinnati Children’s Hospital Medical Center in Ohio, USA, and co-authors.

The researchers reviewed the medical records of 2738 people aged 0.5 to 25.0 years (median 15.8 years) who were admitted to a medical, surgical or psychiatric nonintensive care ward for a primary or secondary diagnosis of diabetes at the Cincinnati Children’s Hospital Medical Center between January 2016 and December 2021.

The patients continued with a home pump or a hospital-supplied insulin pump on the discretion of the medical team. Contraindications to home pump use included impaired consciousness, patient or caregiver inability or unwillingness to demonstrate and continue with self-care, psychiatric illness or lack of pump supplies, the researchers explain.

Of the 18,096 insulin-days recorded, 5.5% were managed using hospital-issued insulin pumps and 4.3% with patient- or caregiver-managed home insulin pumps, while 90.2% were managed with subcutaneous insulin injections.

Hyperglycemia, defined as a glucose level above 250 mg/dL (13.9 mmol/L), occurred on 15.7% of insulin days where a hospital pump was used versus 27.0% with home pump use and 45.2% with subcutaneous injections, a significant difference in favour of either pump use.

Patients using a hospital or home pump were also significantly less likely than patients given injections to experience 1 or more days of moderate hypoglycemia, defined as a glucose level of 45–59 mg/dL (2.5–3.3 mmol/L), at 3.1%, 4.5% and 5.1%, respectively.

But there was no significant difference between the groups with regard to the likelihood of having 1 or more days of severe hypoglycemia (<45 mg/dL or <2.5 mmol/L), at corresponding rates of 0.8%, 1.5% and 1.1%.

None of the patients with a hospital or home pump developed diabetes ketoacidosis versus 0.01% of patients given subcutaneous injections.

Further analysis of the first 20 insulin-days in hospital showed that a comparable 75% of patients using hospital pumps and 70% of those using home pumps achieved glucose levels in the target range of 80–130 mg/dL (4.4–7.2 mmol/L), both significantly higher than the 0% of patients given subcutaneous injections.

“Among patients managed with subcutaneous injections, the mean blood glucose was consistently above the desired range, and there was significantly greater glucose variability […] compared with those using home and hospital pumps”, comment Lawson and team.

While acknowledging the need to inspect and monitor home insulin pumps in children, the researchers conclude: “Collectively, our results show that the use of insulin pumps is, in many ways, more accurate with blood glucose control than subcutaneous injections, and safety is not sacrificed when patients or caregivers use home pumps during pediatric non-intensive care unit admissions.”

Writing in a linked commentary, Molly Regelmann, from Albert Einstein College of Medicine in New York, USA, admits that hospital policies for inpatient home pump use “will need to be adaptable as diabetes technologies are rapidly evolving” and that although the current study did not include the use of hybrid–closed loop insulin pumps, “it seems likely pediatric patients could benefit from their use during hospitalizations”.

Regelmann concludes: “The potential to improve pediatric diabetes care through use of technology during hospitalization will likely not only lead to improved glycemic control during the hospitalizations but has the potential to lead to durable, long-term health care outcome improvements for children and adolescents with diabetes.”

News stories are provided by medwireNews, which is an independent medical news service provided by Springer Healthcare Ltd. © 2024 Springer Healthcare Ltd, part of the Springer Nature Group  

JAMA Netw Open 2024; doi:10.1001/jamanetworkopen.2023.54595

JAMA Netw Open 2024; doi:10.1001/jamanetworkopen.2023.54547