Does insulin pump therapy improve quality of life and satisfaction in children, and adolescents with type 1 diabetes?

Insulin pumps are booming in pediatric diabetology. The objective of this study was to assess changes for children and adolescents with type 1 diabetes using a pump in terms of quality of life (QOL), satisfaction, and glycosylated hemoglobin. A retrospective self-evaluation questionnaire was distributed to 41 patients. It focused on general QOL, diabetes-specific QOL supplemented by specific questions on the pump, and satisfaction Clinical and biological parameters (glycated hemoglobin: HbAlc) were compared before and after pump use. The score for QOL with the pump was positive, more so if started early after diagnosis of diabetes (P = 0.03) and with children under the age of 8 years (P < 0.02). These positive results are mainly related to the characteristics of the pump, "insulin management" and "injections," as well as "diabetes management," "behavior," "school," "family life," "daily life," and "physical activities." On the other hand, the improvement was not significant for the item "life in society, friends and family." A decrease in the number of injections and the flexibility of meals were the most positive points. HbAlc improved as soon as the pump was indicated before its use was begun (P = 0.005) and remained constant for 4 years (P <= 0.05). Forgotten injections, comments on diabetes, and technical problems appeared to be exceptional. The pump changed the patient's body image because of ambivalent feelings between being normal (greater freedom) and different (visibility and a reminder of the disease). The benefits in terms of QOL and glycemic control with the pump cannot be dissociated and can only be considered accompanied by paramedical and medical assistance. Improving QOL over the short and long term by reducing the risk of further complications is the daily challenge of families and diabetologists. (C) 2013 Elsevier Masson SAS. All rights reserved.