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

Andrea E. Scaramuzza Valentina Comaschi Matteo Ferrari Gian Vincenzo Zuccotti About the authors

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. (1Piccini 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.) 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 (2Scaramuzza 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. ). 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 (3Misso 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.) and in adult patients (4Monami 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.), not only in the short run, but even after many years (5Mameli 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.). In patients with Down syndrome and type 1 diabetes, glycemic control may sometimes be particularly tricky (6Kinik 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.,7Lammer 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.).

In our patient, as well as in the one of Piccini and cols. (1Piccini 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.), 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 (8Pinelli 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). Given all of this, pump increased the patient’s and family’s flexibility, as we had previously reported (2Scaramuzza 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. ).

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

  • 1
    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.
  • 2
    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. 
  • 3
    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.
  • 4
    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.
  • 5
    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.
  • 6
    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.
  • 7
    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.
  • 8
    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

Publication Dates

  • Publication in this collection
    June 2014

History

  • Received
    20 Aug 2013
  • Accepted
    24 Jan 2014
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