Insulin Pumps in Type 1 Diabetes with Mental Disorders: Real-Life Clinical Data Indicate Discrepancies to Recommendations
Publication: Diabetes Technology & Therapeutics
Volume 18, Issue Number 1
Abstract
Background: The latest American Association of Clinical Endocrinologists/American College of Endocrinologists consensus statement published in 2014 does not recommend continuous subcutaneous insulin infusion (CSII) in patients with mental health problems. This study investigated the use and discontinuation of CSII in daily routine care of type 1 diabetes (T1D) patients with or without comorbid mental disorders.
Materials and Methods: Insulin-treated T1D patients (n = 48,700) between 5 and 30 years of age (median [interquartile range], 15.6 [12.0–17.7] years) from the German/Austrian diabetes patient follow-up registry (DPV) were studied. A comorbid diagnosis and/or specific treatment of mental disorder was documented in 3,158 (6.5%) patients: attention-deficit hyperactivity disorder (ADHD), n = 1,352; depression, n = 692; eating disorders, n = 395; needle phobia, n = 319; anxiety/obsessive compulsive disorder (OCD), n = 231; and psychosis and/or neuroleptic medication, n = 169. Multivariable logistic regression with age, sex, diabetes duration, and migration background as independent variables was used to compare groups.
Results: After adjustment for confounders, use of CSII was more common in patients with depression (41.5%), anxiety/OCD (41.4%), or needle phobia (75.8%) compared with patients without mental disorders (34.6%) (each P < 0.05). By contrast, psychotic patients (26.2%, P < 0.05) used CSII less often, and patients with ADHD (36.3%) or eating disorders (33.9%) used it with a similar frequency. Compared with patients without mental disorders (5.1%), the rate of CSII discontinuation was higher in patients with ADHD (9.7%), depression (8.2%), or eating disorders (10.0%) (P < 0.05, respectively) but similar in patients with anxiety/OCD (6.0%), psychosis (4.2%), or needle phobia (5.3%).
Conclusions: In routine diabetes care, CSII use and discontinuation vary widely among T1D patients with mental disorders and indicate clear differences from the latest recommendations.
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Information & Authors
Information
Published In
Diabetes Technology & Therapeutics
Volume 18 • Issue Number 1 • January 2016
Pages: 34 - 38
PubMed: 26451621
Copyright
Copyright 2016, Mary Ann Liebert, Inc.
History
Published online: 12 January 2016
Published in print: January 2016
Published ahead of print: 9 October 2015
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Authors
Author Disclosure Statement
S.v.S. reported advisory activity for Medtronic, received speaking fees and reimbursement of travel costs from Bayer Healthcare, Medtronic, Novo Nordisk, and Roche, and obtained three insulin pumps for a research project from Medtronic free of charge. N.P, C.B., M.B., G.B., A.G., H.H., M.M., J.M., P.L.P., M.T., and R.W.H. declare no competing financial interests exist.
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