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Table 1 Studies comparing multiple daily injections (MDI) vs. continuous subcutaneous insulin infusion (CSII) in pediatric patients

From: Insight into hypoglycemia in pediatric type 1 diabetes mellitus

Author Study Design HbA1c Hypoglycemia Other findings
DiMeglio et al. - 42 children <5y/o with DM >1 yr were randomly assigned to CSII or MDI -Improved blood glucose both groups, with better control in CSII group at 3 m, no difference at 6 m follow up - CSII children had increased meter-detected hypoglycemic events - High satisfaction rate with CSII
  - HbA1c, severe hypoglycemia, meter-detected hypoglycemia, blood sugar variability, BMI, and satisfaction with therapy were checked at baseline, 3 m & 6 m   - Both groups had one hypoglycemic seizure  
Litton et al. - 9 toddlers with DM and history of severe hypoglycemia and ketoacidosis were treated with MDI for a mean of 13.7 m, followed by CSII for a mean of 12.7 m - MDI HbA1c average 9.5% ± 0.4% - MDI: mean 0.52 episodes/month - Normal growth & development on pump therapy
  -HbA1c, severe hypoglycemia, growth and development, contact with healthcare professionals, and satisfaction with therapy were followed - CSII HbA1c average 7.9% ± 0.3% (p < 0.001 difference) - CSII: mean 0.09 episodes/month - No change in frequency of physician or ER visits for acute hyperglycemia or ketoacidosis
     - >80% decline in contact with healthcare professionals indicating more independence
     - Subjective improvement in quality of life, satisfaction with CSII
Hanas et al. - 1 year cross-sectional study of 7-21 year old patients, with 27 on CSII and 62 on MDI - MDI HbA1c 8.2% ± 1.6% MDI incidence of: - No admissions for ketoacidosis in either group during cross-sectional study year
  - HbA1c, severe hypoglycemia, and ketoacidosis were followed, with 5 year follow-up of CSII patients - CSII HbA1c 8.9% ± 1%, however 67% of patients had high HbA1c as the reason for CSII therapy. Mean baseline 1y before study 9.5%, lowered to 8.9% at 1 and 5 year follow-ups - Severe hypoglycemia - 40.3/100 patient years - 5 year follow up of CSII patients revealed incidence of ketoacidosis of 4.7/100 per patient year, indicating low risk
    - With unconsciousness- 12.9/100 patient years  
    - Seizures- 9.7/100 patient years  
    CSII incidence of:  
    - Severe hypoglycemia- 11.1/100 patient years  
    - No episodes with unconsciousness or seizure