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

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