RESUMO
OBJECTIVE: To determine whether use of the internet-based insulin pump monitoring system, Carelink, improved glycemic control in rural and urban children treated with insulin pump therapy. RESEARCH DESIGN: We reviewed records of 94 children treated with insulin pump therapy between the years 2004 and 2007 and compared glycemic control, diabetes self-care measures, frequency of clinic visits, and geographic location associated with Carelink use. RESULTS: Carelink users showed improvement in hemoglobin A1c (HbA1c) levels [8.0 +/- 0.1 (SE) vs. 7.7 +/- 0.1 (SE), p = 0.002]. Carelink users uploaded pump and glucometer data 2.2 +/- 1.8 (SD) times per month over 0.8 +/- 0.4 (SD) yr. Patients who had no access to carelink software and were followed in a conventional manner showed no change in HbA1c levels [8.0 +/- 0.2 (SE) vs. 8.1 +/- 0.2 (SE), p = 0.17] during the study period. Carelink non-users, defined as patients who had Carelink access but did not use it, had a higher HbA1c level at the start of the study and did not change over the study period [8.9 +/- 0.2 (SE) vs. 9.0 +/- 0.3 (SE), p = 0.82]. Rural Carelink users showed improvement in HbA1c levels following Carelink use [7.9 +/- 0.2 (SE) vs. 7.4 +/- 0.2 (SE), p = 0.001], yet had significantly fewer clinic visits per year compared with urban patients [2.8 +/- 0.2 (SE) vs. 3.5 +/- 0.1 (SE), p = 0.001]. CONCLUSION: Use of the Carelink system was associated with improved glycemic control in children with type 1 diabetes on insulin pump therapy.