Prospective Study of the Impact of Insulin Pump Therapy in Young Children With Type 1 Diabetes

The purpose of the study is to examine glycemic and neuropsychological outcomes in very young children with Type I diabetes who are being started on insulin pumps and to compare their outcomes to children who are not utilizing insulin pumps. We propose to assess 40 children with IDDM under 5 years of age. 10 patients examined will be using multiple daily injections with basal glargine, 10 will be using NPH or Lente and rapid-acting insulin, and 20 will be examined prior to and 12 months after the implementation of insulin pump therapy. These subjects will be recruited and followed because they are currently undergoing treatment for Type 1 diabetes. Children will be recruited based upon the insulin regimen that they and their primary diabetes physician have chosen to utilize clinically. Insulin regimens will not be changed by the study team. Outcome measures will examine: glycemic outcomes (overall control, blood sugar variability), cognitive outcomes, parenting Stress, and changes in diet.

Children diagnosed with type 1 diabetes for at least one year at the time of study. In addition, children must be under the age of 5 years

• Insulin Pump Therapy
  Children starting insulin pump therapy within six months. Children must be diagnosed with type 1 diabetes for at least one year and under the age of 5 years.
• Insulin Injections
  Children must be diagnosed with diabetes for at least one year at the time of the study. They must be under the age of 5 and receive at least 2 insulin injections daily.

Inclusion Criteria:

1. Children with Type I diabetes:

   • 24 who have had insulin pump therapy recommended by their primary diabetes caretaker.
   • 13 using NPH or Lente insulin plus rapid acting insulin
   • 13 using glargine insulin
2. Children must be 5 years of age or less at the time of entry into the study.
3. Children must have had a diagnosis of type I diabetes for at least 1 year at time of entry.
4. Children must be receiving two or more insulin injections daily.
5. In order to be tested, the child must not have had any moderate or severe hypoglycemia (blood glucose <60 mg/dl) for the 24 hours preceding the testing as documented by home glucose testing.

Exclusion Criteria:

1. Children will be excluded if they have additional medical problems requiring treatment with agents known to affect blood glucose such as steroids or L-asparaginase.
2. Children must not have any other chronic illness in addition to diabetes.