Age, Male Gender, and Social Deprivation Are Associated with a Lower Rate of Insulin Pump Therapy Initiation in Adults with Type 1 Diabetes: A Population-Based Study
Publication: Diabetes Technology & Therapeutics
Volume 23, Issue Number 1
Abstract
Objectives: The objective of this population-based study was to identify factors associated with insulin pump therapy initiation in adults with insulin-requiring diabetes in France in 2015.
Method: People with insulin-requiring diabetes and their characteristics were identified from the national health data system. Factors associated with insulin pump therapy initiation were identified by logistic regression analysis.
Results: The study focused on 614,913 adults with diabetes treated by multiple daily injections before 2015: 4083 of them initiated insulin pump therapy during the year (71% of them had type 1 diabetes, T1D). Factors associated with insulin pump therapy initiation were the number of consultations with an endocrinologist within the past 2 years (2 vs. 0, odds ratio [OR] = 1.5, P < 0.01), the presence of a chronic cardiovascular or neurovascular disease (OR = 1.6 for T1D, OR = 1.3 for type 2 diabetes [T2D], P < 0.01) and treatment with antidepressants/anxiolytics (OR = 1.2 for T1D, OR = 1.4 for T2D, P < 0.01). The other determinants were female gender (OR = 1.5, P < 0.01) and history of hospitalization for acute metabolic complications (OR = 1.14, P < 0.01) in T1D. Factors associated with less insulin pump therapy initiation were age, duration of diabetes, end-stage renal disease, and social deprivation (OR = 0.662, P < 0.01, T1D only).
Conclusion: Predictive factors of insulin pump therapy initiation in people with insulin-requiring diabetes in 2015 in France were globally consistent with clinical practice guidelines. Age, male gender, and social deprivation are still associated with a lower rate of insulin pump therapy initiation in adults with T1D.
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Information & Authors
Information
Published In
Diabetes Technology & Therapeutics
Volume 23 • Issue Number 1 • January 2021
Pages: 8 - 19
PubMed: 32522046
Copyright
Copyright 2021, Mary Ann Liebert, Inc., publishers.
History
Published in print: January 2021
Published online: 31 December 2020
Published ahead of production: 10 June 2020
Topics
Data Availability
The data supporting the findings of this study are available from the SNIIRAM/SNDS database. Analyses of the SNIIRAM/SNDS databases have been approved by the French personal data protection agency. Restrictions apply to the availability of these data and may not be publicly available.
Authors
Authors' Contributions
A.-S.A., C.G.-M., A.F.-C., Y.V., and L.M. designed the study. L.M. and A.-S.A. collected the data. L.M., A.-S.A., and D.V. analyzed the data. L.M., A.-S.A., C.G.-M., and Y.V. wrote the first draft. C.A. wrote particularly the introduction and discussion. Finally, all authors wrote, and contributed to the interpretation of the data, revised critically each versions of draft, and globally participated to the whole aspect of the study. C.A. and C.G.-M. take full responsibility for the study as a whole, including the study design, access to data, and the decision to submit and publish the article.
Author Disclosure Statement
No competing financial interests exist.
Funding Information
The project was supported by the French national health insurance.
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