Changes in Glycemic Control and Quality of Life in Pediatric Type 1 Diabetics with Continuous Subcutaneous Insulin Infusion of Insulin Aspart Following Multiple Daily Injection Therapy

The efficacy of continuous subcutaneous insulin infusion (CSII) of the rapid-acting insulin analogue, insulin aspart, was evaluated in 26 patients with childhood-onset type 1 diabetes aged between 6 and 18 yr who had been on basal-bolus therapy (multiple daily injection (MDI) of regular human insulin or rapid-acting insulin and intermediate/long-acting insulin). The glycemic control in the patients was evaluated based on changes in the clinical parameters and the patient quality of life (QOL) was evaluated by using the insulin therapy-related QOL questionnaire. Twenty two patients continued CSII during the 6-mo study period. The mean HbA1c was 7.8 ± 1.8% at baseline and it decreased to 7.4 ± 0.8% at 6 mo after the start of the CSII. Overall, no decrease of the QOL post-CSII initiation was noted. The possible superiority of CSII as compared to MDI was suggested for patients who “eat out” or “have to look for an appropriate place for insulin injection.” Aside from an inadequate indwelling needle placement detected after the initiation of CSII in several patients, no adverse event associated with NovoRapid^® was seen. In conclusion, CSII of rapid-acting insulin appears to be a useful therapy for patients with childhood-onset type 1 diabetes.     

Multiple Insulin Injections in Adolescent Diabetics Using a Pen-Type Syringe

Multiple insulin injections using the NovoPen, a new device for insulin administration, were given for 12 weeks to seven adolescent patients with insulin-dependent diabetes mellitus (ages: 13–18 years; duration of diabetes: 4–14 years). Human Actrapid insulin was injected before every meal using the NovoPen, and human Monotard insulin was injected at bed-time with a conventional syringe. The mean total daily insulin doses at the beginning and end of the study were 1.3 and 1.2 U/kg body weight, respectively. Monotard insulin was increased during the study. Blood HbAl values declined from 16% to 13% in two patients. The incidence of hypoglycemia did not increase and severe hypoglycemia did not develop. No patient reported difficulty in using the NovoPen. Some, however, had problems in administering insulin at school, but they preferred to continue using the device. The results show that, for adolescent patients,.the NovoPen offers advantages in management and may improve diabetic control.     

Clinical Evaluation of the Needle-free Injection System VISION? for Growth Hormone Therapy in Children

The aim of this study was to compare the therapeutic effects of rhGH administered either by subcutaneous needle-injection (pens) or subcutaneous needle-free jet-injection (VISION^®). Furthermore, a survey was carried out after using VISION^® for 12 mo. A needle-free injection group consisting of 18 subjects (11 males and 7 females, mean age 5.87 ± 2.05 yr at the start of hGH therapy) who have not used pen injectors to date, were allowed to use VISION^® in their third to fifth years of GH therapy. In addition, a group of 8 subjects who had been using pen injectors at our clinic (6 males and 2 females, mean age 6.54 ± 2.78 at the start of GH therapy) was monitored as a control. The results indicate that there are no significant differences between the mean growth rates, growth rate SD scores or height SD scores when comparing injection devices. Furthermore, the survey of VISION^® revealed that 70% of the subjects found it slightly or not painful at or after injection, 70% found VISION^® very easy or easy to use, and 80% found the weight of the device appropriate. All subjects expressed a desire to continue using VISION^® in the future. Our results suggest that there are no problems with the effectiveness of hGH treatment with VISION^®, a needle-free jet-injection device and that VISION^® is an effective device for children who have an aversion to needle injection.     

Prediction of Starting Dose for Conventional Insulin Treatment (Using the Practical Closed-Loop System)

This study was undertaken in 10 newly diagnosed diabetic children to assess the usefulness of the practical closed-loop system in determining insulin doses in conventional treatment. During application of this system of continuous intravenous insulin infusion, the infusion dose was changed according to the hourly monitored blood glucose values. Conventional insulin treatment was started, based on the daily insulin profile obtained by the practical close-loop system. This consisted of two daily injections of a mixture of short- and intermediate-acting insulins. There was no significant difference in mean blood glucose, M-value or mean amplitude of glycemic excursions between the two treatments. Compared with the previous insulin regimen in which conventional insulin treatment was performed following the initial treatment for diabetic ketoacidosis without this practical closed-loop system, good glycemic control was obtained in a shorter period by using this system. Thus, the practical closed-loop system could be helpful in predicting the starting insulin dose for conventional insulin treatment.     

应用胰岛素泵治疗1型糖尿病患儿不同依从性的原因与对策

目的探讨应用胰岛素泵治疗1型糖尿病(T1DM)患儿不同依从性的原因与对策。方法对2000年1月-2008年12月在天津市儿童医院收治的T1DM患者278人次,采用自行设计的T1DM胰岛素泵治疗调查问卷,分析影响糖尿病患者胰岛素治疗依从性的原因,并探讨相应的对策。结果T1DM患者278人次中,85.25%(237人次)同意胰岛素泵治疗,14.75%(41人次)拒绝胰岛素泵治疗。<3岁患者中58.33%(21人次)同意胰岛素泵治疗,>3岁患者中89.26%(216人次)同意胰岛素泵治疗,差异有统计学意义(χ2=23.83,P<0.01);第1次接触胰岛素泵者208人次中82.69%(172人次)同意胰岛素泵治疗,曾使用胰岛素泵或是否接触过使用胰岛素泵的患者中92.86%(65人次)同意胰岛素泵治疗,差异有统计学意义(χ2=4.30,P<0.05)。同意胰岛素泵治疗者与拒绝胰岛素泵治疗者对T1DM的认识得分(t=2.11,P<0.05)和对胰岛素泵的认识得分(t=10.53,P<0.01)的差异均有统计学意义。在治疗过程中由同意改为拒绝胰岛素泵治疗的主要原因为患者有异物感、使用过程中出现故障、发生低血糖;由拒绝改为...     

Feasibility of a Day-Camp Model of Modified Constraint-Induced Movement Therapy With and Without Botulinum Toxin A Injection for Children With Hemiplegia

The objective of the study was to investigate the feasibility of modified constraint-induced (CI) therapy provided in a 2-week day-camp model with and without intramuscular botulinum toxin type A (BoNT-A) injections for children with congenital cerebral palsy. Sixteen children with congenital hemiplegia, Manual Ability Classification System (MACS) level I and II, aged 8–17 years, participated in a CI therapy day camp; of whom five participants (aged 11–16 years) received intramuscular BoNT-A prior to CI therapy. Assessments were conducted 4 months and 2 weeks before (baselines 1 and 2), immediately after, and 6 months after the day camp. For the children who received BoNT-A, no statistical analyses were conducted due to the small size of the sample. In this group, consistent improvement was only found according to the Melbourne Unilateral Limb Assessment. The children who received only the CI therapy demonstrated improvements in the Jebsen–Taylor Hand Function Test (p =. 04) at posttest, but improvements were not sustained at 6-month follow-up. No significant improvement was obtained for the Melbourne Assessment or the Assisting Hand Assessment. Children in both groups improved on specially trained tasks: frisbee golf, stacking blocks, and in-hand manipulation. Feedback from the participants suggests that the day-camp model is a feasible intervention following intramuscular BoNT-A injections. The results suggest that children with congenital hemiplegia with varying severity of impairment in hand function may benefit from CI therapy, but not every child demonstrates improvements in hand function. The characteristics of children who respond the best to CI therapy are not clear.     

The OECD Family Database: Developing a Cross-National Tool for Assessing Family Policies and Outcomes

The OECD Family database has been developed to collate in one central location information and indicators relating to family outcomes, family policies and children in order to address the growing demand for cross-national information on the situation of families and children. The information is taken from different OECD databases, specifically developed questionnaires and non-OECD sources. The OECD Family database now includes 52 indicators across four broad headings: the structure of families, families and children, the labour market position of families, public policies for families and children, and child outcomes. This paper presents the Family database and discusses data and methodological issues as illustrated by selected example indicators.     

The Failing Fontan: Options for Surgical Therapy

The Fontan procedure has been a significant contribution to the therapeutic armamentarium of congenital heart surgeons for the treatment of single ventricle anomalies. However, it has its limitations. Patients may have failure of the Fontan circulation acutely postoperatively or late during the long-term follow-up. Early failure is often related to an intraoperative myocardial injury or unsuspected elevated pulmonary vascular resistance; this has a very high mortality. Late failure of the Fontan procedure may present with symptoms typical for heart failure. However, protein-losing enteropathy is another condition related to late failure of the Fontan operation. Late failure may be related to a number of different factors, many of which are amenable to reoperation. Every effort should be made to identify which hemodynamic factors are responsible for late failures. However, cardiac transplantation will likely be necessary for the majority of patients.