Reasons for the discontinuation of therapy of personal insulin pump in children with type 1 diabetes.

Introduction: Pump discontinuation is rare. It is estimated that only about 4% of patients return to multiple daily injections (MDI).

Objective: To study the factors that influence the decision to stop continuous subcutaneous insulin infusion therapy (CSII).

Material And Methods: Analysis of the anonymous questionnaires indicating factors that influenced pump discontinuation and return to the MDI.

Respondents: 30 children (17girls), mean age 14.3yr(± 3,57), at the start of CSII 11.06yr(± 4.01), at discontinuation of pump therapy 13,23yr(±3,82).

Results: The mean duration of pump usage was significantly higher in boys: 3.28yr±2.31 vs 1, 27yr±1.04(p=0.01); mean HbA1c: boys-8.03%±1.03, girls-7.78±1.42. The most frequently reported disconnection reasons were: greater sense of disease (93%), difficulties in doing sports (70%), worse well-being during pump therapy (63%), having to attach the pump to the body (60%), embarrassment (56%), adhesions and pain in the place of needle insertion (50%), difficulties in controlling glycemia during physical exercise, fear (43%), high levels of HbA1c (36%), frequent blood glucose monitoring (26%). Problems with technical operation of the pump or frequent episodes of severe hypoglycemia or ketoacidosis were not reported. Among those who indicated difficulty in controlling glycaemia during physical exercise or infection, the average age at the time of quitting the pump was significantly lower than the rest: 12.3±3.33 vs. 14.69 ±2.82 (p=0.04).

Conclusions: The individual psycho-emotional state of the child and appropriate education are important at the start and continuation of CSII.