Insulin pump treatment in children aged 3.0 – 6.0 years in Bulgaria: Sustaining the optimal control

Insulin pump treatment in Bulgaria started in 2007. The results for the first 29 patients were satisfying but the following years showed deterioration in some patients. The country needed a team of educated nurses for pump treatment. The 6-months project aimed: To start pump treatment in 12 type 1 diabetes children, aged 3.0 to 6.0 years, attending a kindergarten /6 girls/ and to evaluate the change in the HbA1c, the proportion for basal/bolus dose and the ratio of insulin/body weight. To educate a team of diabetes nurses for the kindergarten
Organization:
Structured education for the parents
An informed consent signed by both parents
Anthropometry and HbA1c at the start and follow up
Sensor-augmented pump after the initial 3 months
Starting basal dose – 50% of the total daily dose /TDD/
Bolus wizard from the beginning
3 nurses from the University clinic for diabetes – Sofia gave duties daily in the kindergarten to educate the nurses in the kindergarten
Results:
Basal dose for 5 patients is 50%; in one - 52% and for six patients 40 - 45% of the TDD
Insulin/body weight ratio: 0.65±0.136IU/kg.  
HbA1c decreased from 8.47 % /60.3 mmol/mol/ to 7.21% /51.33 mmol/mol/ /p<0.001/at the end of the first year and is sustained 3 years after: the latter is 7.3% without adverse events /DKA, severe hypoglycemia, injection site reactions/
All the parents and children are very satisfied with the continuous subcutaneous insulin infusion /CSII/ and with the exception of one family still continue it.