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The goal of this article was to review studies comparing continuous subcutaneous insulin infusion (CSII) to multiple daily insulin injections (MDIs) in children and adolescents with type I diabetes on five parameters: glycemic control, adverse events, required insulin dosage, weight gain, and psychosocial implications. Two of the five studies (sample sizes 19-75 patients) showed that insulin pumps provided better glycemic control, fewer adverse events, and better psychosocial implications than MDIs. Three of the five showed a lower required insulin dosage in CSII and one of the five showed less weight gain with CSII. Studies 4 and 5, both done in preschoolers, showed no significant difference on any of the five parameters. The majority of the patients and families chose to continue with CSII after the completion of the studies, even in studies where insulin pumps showed no objective benefit. Insulin pumps appear to offer potential benefit over MDIs, but the efficacy, safety, and cost effectiveness of CSII versus MDIs as first-line therapy for type I diabetes in this population has not yet been clearly established. Until more data are available from large, randomized, controlled studies, MDIs may be used as first-line therapy and CSII should be considered in patients who have poor glycemic control or who are not compliant with multiple injections.

Klinefelter syndrome is a common condition that remains underdiagnosed, particularly prior to adulthood. Early detection could prevent morbidity and mortality, but the classic phenotype of small testes and tall stature may not be apparent until adolescence, and there is minimal guidance regarding whom to screen. We performed a retrospective study at Boston Children’s Hospital in patients with the ICD-9 code for “Klinefelter syndrome” diagnosed prior to age 20 years, and determined age and reason for diagnosis, karyotype, heights, and comorbid conditions. Eighty percent had a 47,XXY karyotype, of whom half were diagnosed at age 11 to 19 years. The most common comorbidities were neurocognitive, including learning disabilities (67%), psychosocial problems (33%), and attention deficit disorder (27%). Subjects were only slightly taller than average in childhood (height standard deviation score = 0.64). These data show that Klinefelter syndrome is associated with long-standing comorbidities that frequently remain under-recognized; a karyotype should be considered in boys with neurocognitive problems.