Long-Term Effectiveness of Continuous Subcutaneous Insulin Infusion in the Prevention of Hypoglycemia in Adults with Type 1 Diabetes
Publication: Diabetes Technology & Therapeutics
Volume 21, Issue Number 8
Abstract
Background: Reducing hyperglycemia while avoiding hypoglycemia is the key clinical goal in managing people with type 1 diabetes. Insulin delivery techniques and regimens are constantly evolving to achieve these goals. At present, use of multiple daily injections (MDI) is the standard of care, but there is increasing interest in continuous subcutaneous insulin infusion (CSII). There is a deficit of studies comparing long-term glycemic control and hypoglycemia outcomes between these therapeutic options.
Methods: This was a single-center, retrospective cohort study of adults with type 1 diabetes. Data were derived from electronic medical records and included demographic and clinical factors. Participants had all undergone intensive diabetes education, followed by CSII or continued MDI. The primary outcome was difference in hypoglycemia, defined as the percentage of self-monitoring blood glucose levels less than 3.9 mmol/L. Up to 10 years of follow-up data were available, between 2000 and 2016.
Results: There were 69 participants using CSII and 78 using MDI. Self-monitoring blood glucose data showed significantly less hypoglycemia with CSII by over 30%, occurring as early as the first year and sustained throughout the follow-up period (P < 0.001). This benefit of CSII on reducing hypoglycemia was independent of more frequent hypoglycemia and higher body weight at baseline, factors that were also independently associated with reduced hypoglycemia.
Conclusions: In selected adults with type 1 diabetes, long-term CSII can provide long-term clinically relevant and sustained reductions in hypoglycemia, particularly in those with greater initial risk of hypoglycemia and higher body weight, and improved glycemic control compared with MDI.
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Information & Authors
Information
Published In
Diabetes Technology & Therapeutics
Volume 21 • Issue Number 8 • August 2019
Pages: 423 - 429
PubMed: 31180239
Copyright
Copyright 2019, Mary Ann Liebert, Inc., publishers.
History
Published in print: August 2019
Published online: 22 July 2019
Published ahead of print: 10 June 2019
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Disclosure Statement
J.C.S., Z.A.F., and L.N.J.L.: No competing conflict of interests exists. E.M.B.: Honoraria: Boehringer Ingelheim, Eli Lilly, Novo Nordisk, and ApoPharma; educational grants: Boehringer Ingelheim, Eli Lilly, Novo Nordisk, and Sanofi; travel funding: Boehringer Ingelheim, Eli Lilly, and Novo Nordisk. N.D.C.: Honoraria: AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Medtronic, MSD, Novo Nordisk, and Sanofi; educational grants: Medtronic, MSD, and Sanofi; travel funding: Abbott, Eli Lilly, MSD, Novo Nordisk, and Sanofi.
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