Diabetes patient profiles
PAEDIATRICS PATIENTS WITH TYPE 1 DIABETES
Considerations for pediatrics patient with diabetes.
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Diabetes in children with frequent hypoglycaemia
- 3 years-old. Type 1 diabetes for 1 year
- MDI – rapid acting insulin before meals and long acting insulin in the evening
- HbA1c: 7,1% (54.1mmol/mol)
The patient has frequent hypoglycaemia events; 4 times a week, and has been hospitalised 5 times this year for severe hypoglycaemia events. The parents check her BG 4 times during the night due to fear of hypoglycaemia. Her frequent low blood sugar level events and the difficulty to anticipate what she will eat make it impossible for her to go to day-care, therefore her mother had to stop working.
The goal for this family is to reduce the frequency of hypoglycaemia events in order to improve their quality of life, decrease their stress and allow Julia to live as normal a life as possible.
TREATMENT CONSIDERATIONS FOR CHILDREN WITH FREQUENT HYPOGLYCAEMIA
Children with frequent hypoglycaemia are good candidates for CSII and/or SAP therapy1,2,3:
DIABETES IN CHILDREN WITH ELEVATED HBA1C
- 8 years old, has had type oneType 1 diabetes for 3 years
- MDI - rapid acting insulin before meals and long acting insulin in the evening
- HbA1c: 8% (64mmol/mol)
The patient has needle phobia, so when he has snacks or sweets, he never injects his insulin. This makes it impossible to get his blood glucose under control, and the patient’s HbA1c remains far above target. His school teacher also noticed that he has difficulty remaining focused.
The goal is to reduce Tom’s HbA1c and achieve better glycaemic control.
TREATMENT CONSIDERATIONS FOR CHILDREN WITH ELEVATED HbA1c
CSII and SAP therapy are recommended if the target of HbA1c can’t be reached or if the patient is unsatisfied with another diabetes treatment option5,6,7.
1MA Berghaeuser et al., Continuous subcutaneous insulin infusion in toddlers starting at diagnosis of type 1 diabetes mellitus. A multicenter analysis of 104 patients from 63 centres in Germany and Austria. Ped Diab 2008 9:(6) 590–595.
2De Bock M, et al. Impact of insulin pumps on glycaemic control in a pump-naïve paediatric regional population. J Paediatr Child Health. 2012 Mar;48(3):247-52.
3Bergenstal RM, Klonoff DC, Garg SK. et al. Threshold-Based Insulin-Pump Interruption for Reduction of Hypoglycemia, N Engl J Med. June 22, 2013DOI: 10.1056 / NEJMoa1303576.
4Ly TT et al. Effect of sensor-augmented insulin pump therapy and automated insulin suspension vs standard insulin pump therapy on hypoglycemia in patients with type 1 diabetes: a randomized clinical trial. JAMA. 2013 Sep 25;310(12):1240-7
5Skosberg Pediatric Diabetes 2008: 9: 472–479. Improved treatment satisfaction but no difference in metabolic control when using continuous subcutaneous insulin infusion vs. multiple daily injections in children at onset of type 1 diabetes mellitus.
6Battelino T et al, Conget I, Olsen B, Schütz-Fuhrmann I, Hommel E, Hoogma R, Schierloh U, Sulli N, Bolinder J; SWITCH Study Group. The use and efficacy of continuous glucose monitoring in type 1 diabetes treated with insulin pump therapy: a randomised controlled trial. Diabetologia. 2012 Dec;55(12):3155-62.
7Slover RH et al. Effectiveness of sensor-augmented pump therapy in children and adolescents with type 1 diabetes in the STAR 3 study. Pediatr Diabetes. 2012 Feb;13(1):6-11.
Pain free insulin injection therapy
INSULIN PUMP THERAPY (CSII)
Introducing patients to new technologies and clinical practices
SENSOR AUGMENTED PUMP THERAPY (SAP)
Incorporating Continuous Glucose Monitoring to reduce HbA1c and improved glycaemic control.