A decade of insulin pump therapy in a Belgian paediatric diabetes centre: longitudinal outcomes and evolving practices.

AIMS: Continuous subcutaneous insulin infusion (CSII) is standard care in paediatric type 1 diabetes (T1D). This study evaluated 11-year trends in CSII adoption, device evolution, indications, discontinuation, and metabolic outcomes in a paediatric diabetes centre.

METHODS

We conducted a retrospective cohort study of children and adolescents with T1D followed from 2013 to 2024. Data included age at diagnosis and pump initiation, prior insulin regimen, device type, HbA1c, acute complications, and reasons for discontinuation or switching. Time to pump discontinuation was analysed using Cox regression.

RESULTS

CSII adoption increased to 41% of the centre's cohort by 2024. Devices evolved from 100% standalone pumps in 2013 to 54% hybrid closed-loop systems in 2024. At initiation, 36% started CSII within the first week after diagnosis, 58% transitioned from twice-daily injections, and 6% from multiple daily injections. Reasons for initiation included lifestyle considerations (51%), avoiding injections (21%), and suboptimal glycaemic control (13%). Mean HbA1c improved modestly over 5 years, with rare severe hypoglycaemia or ketoacidosis. CSII discontinuation occurred in 11%, mainly patient-driven, while 37% were physician-driven due to non-compliance. Older age at pump initiation was associated with discontinuation (HR 1.422, 95% CI 1.224-1.651; p < 0.001). Device switching occurred in 21%, mostly to access newer features.

CONCLUSIONS

CSII adoption increased substantially over the study period, accompanied by a shift toward hybrid closed-loop systems and stable metabolic outcomes. Early initiation at diagnosis was feasible and safe. These real-world findings highlight the importance of education, adherence support, and multidisciplinary care in optimizing long-term paediatric CSII use.