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Arquivos Brasileiros de Endocrinologia & Metabologia

On-line version ISSN 1677-9487

Arq Bras Endocrinol Metab vol.58 no.4 São Paulo June 2014

https://doi.org/10.1590/0004-2730000002948 

Carta ao Editor

Sensor-augmented pump and Down syndrome: a new tool in tricky patients

Andrea E. Scaramuzza1 

Valentina Comaschi1 

Matteo Ferrari1 

Gian Vincenzo Zuccotti1 

1Department of Pediatrics, Pediatric Diabetology Unit, University of Milano, ‘Luigi Sacco’ Hospital, via Giovanni Battista Grassi, Milano, Italy


Response to “Specific use of CSII during enteral nocturnal nutrition in a child with type 1 diabetes, Hashimoto’s thyroiditis, and Down syndrome”

We read with great interest the paper by Piccini and cols. (1) published in the July issue of this Journal.

Some years ago, we published the first report ever (to the best of our knowledge) of successful treatment of a girl with Down syndrome, Hashimoto’s thyroiditis and celiac disease with continuous subcutaneous insulin infusion (2). Since then, her glycemic control was kept constant and, most of the time, in the target range (HbA1c in 2009: 7.75 ± 0.21%; HbA1c in 2010: 7.35 ± 0.19%; HbA1c in 2011: 7.42 ± 0.30%).

At the end of 2011, sensor-augmented pump was initiated (Animas® VibeTM, West Chester, PA, USA) because of both a quite high glycemic variability and the parents’ request, and her HbA1c kept improving (HbA1c in 2012: 7.30 ± 0.20%; HbA1c in 2013: 7.10 ± 0.28%).

CSII has been recognized as effective and safe in pediatric (3) and in adult patients (4), not only in the short run, but even after many years (5). In patients with Down syndrome and type 1 diabetes, glycemic control may sometimes be particularly tricky (6,7).

In our patient, as well as in the one of Piccini and cols. (1), CSII was a safe and effective way to manage diabetes.

For a successful CSII therapy in a patient with Down syndrome, whose mental function may be impaired, the collaboration of a highly motivated and compliant family is essential, as well as a skilled multidisciplinary diabetes team (8). Given all of this, pump increased the patient’s and family’s flexibility, as we had previously reported (2).

The significant improvement in the glycemic control observed, and the high level of acceptance of CSII therapy observed in both our case and in that of Piccini and cols. is worth the effort of the patient’s family and of the diabetes team in ensuring that the patient has a flexible life.

Perhaps CSII therapy might be taken into account when considering insulin therapy in patients with Down’s syndrome.

REFERENCES

Piccini B, Toni S, Lenzi L, Barni F, Guasti M, Belli F, et al. Specific use of CSII during enteral nocturnal nutrition in a child with type 1 diabetes, Hashimoto’s thyroiditis, and Down syndrome. Arq Bras Endocrinol Metabol.2013;57:388-92. [ Links ]

Scaramuzza AE, Giani E, Riboni S, Spiri D, De Palma A, Mameli C, et al. Insulin pump therapy for type 1 diabetes treatment in a girl with Down’s syndrome. Diabetes Res Clin Pract. 2009;85:e16-8.  [ Links ]

Misso ML, Egberts KJ, Page M, O’Connor D, Shaw J. Continuous subcutaneous insulin infusion (CSII) versus multiple insulin injections for type 1 diabetes mellitus. Cochrane Database Syst Rev. 2010;(1):CD005103. [ Links ]

Monami M, Lamanna C, Marchionni N, Mannucci E. Continuous subcutaneous insulin infusion versus multiple daily insulin injections in type 1 diabetes: a meta-analysis. Acta Diabetol. 2010;47(suppl 1):77-81. [ Links ]

Mameli C, Scaramuzza AE, Ho J, Cardona-Hernandez R, Suarez-Ortega L, Zuccotti GV. A 7-year follow-up retrospective, international, multicenter study of insulin pump therapy in children and adolescents with type 1 diabetes. Acta Diabetol. 2014;51(2):205-10. [ Links ]

Kinik ST, Ozcay F, Varan B. Type I diabetes mellitus Hashimoto’s thyroiditis and celiac disease in an adolescent with Down syndrome. Pediatr Int. 2006;48:433-5. [ Links ]

Lammer C, Weimann E. Early onset of type I diabetes mellitus, Hashimoto’s thyroiditis and celiac disease in a 7-yr-old boy with Down’s syndrome. Pediatr Diabetes. 2008;9(4 Pt 2):423-5. [ Links ]

Pinelli L, Rabbone I, Salardi S, Toni S, Scaramuzza A, Bonfanti R, et al. Insulin pump therapy in children and adolescents with type 1 diabetes: the Italian viewpoint. Acta Biomed. 2008;79:57-64. letter to the editor [ Links ]

Received: August 20, 2013; Accepted: January 24, 2014

Correspondence to: Andrea E. Scaramuzza Clinica Pediatrica Azienda Ospedaliera, Università di Milano, “Ospedale Luigi Sacco” Via G. B. Grassi, 74 20157 – Milan, Italy scaramuzza.andrea@hsacco.it

Disclosure: no potential conflict of interest relevant to this article was reported.

Creative Commons License This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.