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Poor adherence to integral daily tasks limits the efficacy of CSII in youth.
MedLine Citation:
PMID:  21466646     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
O'Connell MA, Donath S, Cameron FJ. Poor adherence to integral daily tasks limits the efficacy of CSII in youth. Introduction/Aims: Many young people experience improved glycemia with continuous subcutaneous insulin infusion (CSII) regimens; however, sustained glycemic benefit eludes a significant proportion. Our aims were to assess adherence to recommended CSII-related behaviors in a representative pediatric cohort and to identify potentially modifiable behaviors that impact on HbA1c in youth. Research Design and Methods: Data uploaded from insulin pump devices of 100 youth with type 1 diabetes were analyzed. Results: Ability to translate recommended behaviors into daily self-management varied widely in youth. Mean bolus frequency was 6.1/d; however, 69/100 entered <4 blood glucose levels (BGL)/d. HbA1c decreased by 0.2% for each additional BGL (p = 0.001) and bolus event (p < 0.001) per day. Prandial insulin omission was common and associated with significantly increased HbA1c. On average, if breakfast insulin was missed ≥4 times per fortnight, HbA1c increased 1.0% (p < 0.001). If one or more days per fortnight with ≤2 food boluses/d were recorded, then HbA1c increased 0.8% (p = 0.001). Increasing age and duration of CSII correlated with poorer adherence to recommended behaviors. Conclusions: Glycemic advantage obtained with CSII regimens is closely related to the manner in which CSII is employed. Poor adherence to integral CSII-related tasks is frequently encountered in adolescents and limits the efficacy of CSII in these youth.
Authors:
Ma O'Connell; S Donath; Fj Cameron
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-4-6
Journal Detail:
Title:  Pediatric diabetes     Volume:  -     ISSN:  1399-5448     ISO Abbreviation:  -     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-4-6     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100939345     Medline TA:  Pediatr Diabetes     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2011 John Wiley & Sons A/S.
Affiliation:
Department of Endocrinology and Diabetes, The Royal Children's Hospital and Murdoch Childrens Research Institute, Melbourne, Australia Clinical Epidemiology and Biostatistics Unit, The Royal Children's Hospital and Murdoch Childrens Research Institute, Melbourne, Australia.
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