Selecting Children and Adolescents for Insulin Pump Therapy: Medical and Behavioral Considerations
- Fran R. Cogen, MD, CDE,
- Randi Streisand, PhD and
- Seema Sarin, BA
The use of continuous insulin therapy via a subcutaneously implanted catheter connected to an external pump is being used increasingly in the management of childhood type 1 diabetes. This form of intensive diabetes management places multiple demands on young patients to achieve near-normal blood glucose levels. Therefore, appropriate selection of pediatric candidates for pump therapy is critical to achieving successful outcomes.
Although few empirical data are available on readiness evaluations conducted with pump candidates, clinical data suggest several factors important in the consideration of these individuals, including age, medical history, and psychosocial functioning. The focus of this case presentation is to describe key factors for health care professionals to consider in transitioning children and adolescents to the insulin pump, based on our pediatric pump program at Children’s National Medical Center in Washington, D.C.
Case Presentation
S.P., is a 10-year-old boy with a 3-year history of type 1 diabetes. In May 2000, while on three insulin injections per day, he requested insulin pump therapy in order to increase lifestyle flexibility. His height was at the 90–95th percentile, and his weight was at greater than the 75th percentile. His hemoglobin A1c (A1C) concentration was 6.9%. His anticipated pump start was set to coincide with his tenth birthday.
As a requirement of our program, S.P. was asked to learn carbohydrate counting and to obtain psychological consultation per our center’s protocol. After psychological and nutritional evaluations, there were concerns related to untreated anxiety with obsessive-compulsive tendencies as well as the need for additional carbohydrate-counting practice. We therefore delayed his pump start for 5 months and asked S.P. and his family to seek additional psychological counseling and nutritional support to increase the likelihood of pump success.
Discussion
Medical and Behavioral Considerations
Insulin pump therapy provides a more physiologically precise manner of delivering insulin compared to self-injections with less variable insulin absorption …
