Alsaleh, Fatemah Mohammad; (2011) Use of insulin pumps by children and young people in the management of type 1 diabetes mellitus. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Background: Insulin pump therapy or continuous subcutaneous insulin infusion (CSII) was introduced in the UK in the 1970s as a method for achieving strict control of blood glucose concentrations in people with type 1 diabetes mellitus (T1DM). The advancements of medical technology over the years and the research documenting clinical effectiveness have led to the worldwide growth of pump therapy. In the UK, the use of CSII in children is limited and there is little evidence regarding how the management of the condition on their life and that of their families is compared with the injection therapy. Aim: To describe the experiences of children using CSII and, their parents, including glycaemic control, use of pump technology and flexibility in lifestyle for children of different ages and durations of pump therapy. Methods: The study was conducted in the Paediatric Diabetes Clinic at University College Hospital (UCH), London. All patients (N=42) using insulin pumps, and their parents, were invited to participate. Semi-structured interviews were conducted with parents of all children, and children aged 5 years or older. Measures of glycated haemoglobin A1c (HbA1c) values from 6 months prior to, and after pump therapy were also obtained from medical records. Quantitative analysis of structured data was undertaken using the Statistical Package for the Social Sciences (SPSS). Qualitative data were analysed by an iterative process employing a constant comparative approach. Results: Both the parents and the children found it easier to maintain glycaemic control within their target range with insulin pumps compared to injections. This was supported by HbA1c measures and the reported frequency and severity of hypoglycaemic episodes. Whilst participants generally found the device itself easy to use and more acceptable than injections from the start, variable lengths of time were required to develop confidence in carbohydrate counting and dose calculation. Parents and children reported an overall increase in flexibility in lifestyle and their ability to participate in daily activities. This was attributed to more flexible eating patterns and diabetes control, and was manifested by more normal lives at home and schools, and improved socialisation. Conclusion: Parents and children using insulin pumps fund it easier to lead normal lives by being able to maintain glycaemic control and accommodate a more flexible lifestyle, which is a central goal of health policy for children and young people in the UK.

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