%0 Journal Article
%T Insulin Therapy with Personal Insulin Pumps and Early Angiopathy in Children with Type 1 Diabetes Mellitus
%A Joanna To£¿wi¨½ska
%A Barbara G£¿owi¨½ska-Olszewska
%A Artur Bossowski
%J Mediators of Inflammation
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/791283
%X Objective. Assessment of the effect of a treatment method change from multiple daily insulin injection (MDI) to continuous subcutaneous insulin infusion (CSII) on the development of early angiopathy in children with T1DM with or without retinopathy. Methods. The study pump group involved 32 diabetic children aged 14.8, with the initial HbA1c level of 8.3%, previously treated by MDI. The patients were examined before pump insertion and after 3 and 6 months of CSII. We assessed HbA1c level, carotid artery intima-media thickness (c-IMT), and flow-mediated dilatation (FMD) of the brachial artery. The pump group was compared to a group of eight teenagers with diagnosed nonproliferative retinopathy, treated with MDI. Results. HbA1c in the entire group was found to improve in the second and in the third examination. During 6 months of CSII, FMD increased and IMT decreased. Retinopathic adolescents had significantly thicker IMT and lower FMD compared to baseline results of the pump group. Treatment intensification in the retinopathy-free children enhanced these differences. Conclusions. CSII is associated with lower IMT and higher FMD. Whether on the long-run CSII is superior to MDI to delay the occurrence of diabetes late complications remains to be explained. 1. Introduction Insulin pump therapy in the form of continuous subcutaneous insulin infusion (CSII) was introduced in the 1970s and turned out to ensure better metabolic control of diabetes compared to traditional insulin therapy approaches. It is currently considered to be the optimal method of insulin administration, since it imitates the pancreatic activity in the best possible way, ensures precise dosage, and at the same time offers a high level of ease and comfort. Patients that experience the advantages are above all children and adolescents with type 1 diabetes mellitus (T1DM) [1¨C3]. Compared to the traditional methods of insulin therapy by means of multiple daily insulin injections (MDI), CSII can significantly decrease glycated hemoglobin (HbA1C), reduce 24-hour glucose variability, decrease incidence of severe hypoglycemia, and eliminate dawn phenomenon. Moreover, the use of CSII is associated with improved quality of life and precise insulin administration with respect to physical effort and diet [1, 4]. A long-term effect of CSII on the development of late complications of diabetes in the form of microangiopathy or macroangiopathy needs to be explained [5]. T1DM increases the risk of developing micro- and macrovascular complications which in turn will have a devastating impact on quality of
%U http://www.hindawi.com/journals/mi/2013/791283/