Lower dose basal insulin infusion has positive effect on glycaemic control for children with type I diabetes on continuous subcutaneous insulin infusion therapy.

OBJECTIVE: The aim of our study was to explore a possible relationship between proportion of basal insulin dose (%BD/T) and glycaemic control in children with type I diabetes on continuous subcutaneous insulin infusion (CSII) therapy. METHODS: All patients under the age of 18 with type I diabetes mellitus, treated in a general hospital in Utrecht, The Netherlands, who were on CSII therapy between 2000 and 2011 were selected for inclusion. All data as recorded during outpatient visits were retrospectively collected from patients' charts. Analyses were performed using R Statistical Software. RESULTS: Data of 847 outpatient visits of 78 patients [31 males (39.7%) and 47 females (60.3%)] were analyzed. Mean age at diagnosis was 7.1 ± 3.7 yr, mean age at start of pump therapy 10.1 ± 3.8 yr. Mean HbA1c before pump start was 8.3 ± 1.0%, median BMI standard deviation score for age and gender was 0.64 (-1.89-3.79). Median follow-up time per patient was 29 months with an average of 10 visits (range: 3-25). Multivariate analysis revealed that a change of 10% in %BD/T resulted in a decrease or increase of HbA1c of 0.22% [95% confidence interval (CI): 0.15-0.29). No significant effect was observed from SDS BMI, sex, or duration of diabetes. CONCLUSION: Low dose basal insulin infusion as a percentage of total insulin dose has a positive effect on metabolic outcome as expressed in HbA1c-levels. A change of 10% in %BD/T results in a decrease or increase of HbA1c of 0.22%. This supports the tendency to aim at the lowest basal insulin requirements in pump setting strategy.

Delaying a shock after takeover from the automated external defibrillator by paramedics is associated with decreased survival.

INTRODUCTION: The purpose of this study was to investigate whether the takeover by Advanced Life Support [ALS] trained ambulance paramedics from rescuers using an automated external defibrillator [AED] delays shocks and if this delay is associated with decreased survival after out-of-hospital cardiac arrest [OHCA]. METHODS: We analyzed continuous ECG recordings of LIFEPAK AEDs and associated manual defibrillator recordings of OHCA of presumed cardiac cause, prospectively collected from July 2005 to July 2009. The primary outcome measure was survival to discharge. Among 693 patients treated with AEDs, 110 had a shockable initial rhythm and a shockable rhythm during ALS takeover. We measured the time interval between the expected shock if the AED would remain attached to the patient and the first observed shock given by the manual defibrillator [shock timing]. RESULTS: Survival was 62% (13/21) if the shock was given early (<-20s), 52% (11/21; odds ratio [OR]=0.68, ns) if given on time (-20 to 20s), 29% (10/34; OR=0.26, 95% confidence interval [CI]=0.08-0.81; P=0.02) if the shock was 20-150s delayed and 21% (7/34; OR=0.16, 95% CI=0.05-0.54; P=0.003) if the shock was delayed >150s. The OR for trend was 0.41, 95% CI=0.25-0.71; P=0.001. The association between shock timing and survival was significant for patients with more than 150s shock delay (OR=0.19; 95% CI=0.04-0.71; P=0.02) or for trend in shock timing (0.42, 95% CI=0.20-0.84; P=0.02) after multivariable adjustment for prognostic factors age and slope of ventricular fibrillation. CONCLUSIONS: ALS takeover delays the next shock delivery in almost two-third of cases. This delay is associated with decreased survival.