Comparison of different insulin pump makes under routine care conditions in adults with Type 1 diabetes

Abstract

What's new?• Continuous subcutaneous insulin infusion (CSII) is often considered the 'gold standard' insulin replacement therapy for individuals with Type 1 diabetes.• This is the first study to compare long-term changes in HbA 1c associated with different makes of pump under routine care conditions.• We found no significant differences in HbA 1c improvement when comparing different makes of insulin pump, including a comparison of patch pumps and traditional Accepted ArticleThis article is protected by copyright. All rights reserved.catheter pumps, and pre-specified patient subgroups stratified by pre-CSII HbA 1c , age and diabetes duration.• The choice of CSII make should not be influenced by the desired degree of HbA 1c lowering. Abstract ResultsThe pumps compared were: 50% Medtronic, 24% Omnipod, 14% Roche and 12% Animas. Overall HbA 1c levels improved and improvements were maintained during a followup extending to 10 years (HbA 1c : pre-continuous subcutaneous insulin infusion (pre-CSII) vs. 12 months post CSII, 71 (61, 82) vs. 66 (56, 74) mmol/mol; 8.7 (7.7, 9.6) vs. 8.2 (7.3,8.9)%; P < 0.0001). The percentage of individuals with HbA 1c ≥ 64 mmol/mol (8.0%) reduced from a pre-CSII level of 68% to 55%. After adjusting for baseline confounders, there were no between-pump differences in HbA 1c lowering (P = 0.44), including a comparison of patch pumps with traditional catheter pumps (P = 0.63). There were no significant (P < 0.05) between-pump differences in HbA 1c lowering in pre-specified subgroups stratified by prepump HbA 1c , age or diabetes duration. HbA 1c lowering was positively related to baseline Accepted ArticleThis article is protected by copyright. All rights reserved.HbA 1c (P < 0.001) and diabetes duration (P = 0.017), and negatively related to the number of years of CSII use (P = 0.024).Conclusions Under routine care conditions, there were no covariate-adjusted differences in HbA 1c lowering when comparing different pump makes, including a comparison of patch pumps vs. traditional catheter pumps. Therefore, the choice of CSII make should not be influenced by the desired degree of HbA 1c lowering.

Impact of social deprivation, demographics and centre on HbA1c outcomes with continuous subcutaneous insulin infusion

“…Insulin pump therapy, also known as continuous subcutaneous insulin infusion (CSII), is considered the 'gold standard' of insulin replacement therapy for people living with Type 1 diabetes [1]. Use of CSII has been shown to improve overall glycaemic control, as measured by HbA 1c , and reduce the burden of hypoglycaemia [2][3][4].…”

To pump or not to pump

“…In the UK, the National Institute for Health and Care Excellence recommends insulin pump therapy in patients who have struggled to achieve optimal glucose control (HbA 1c >8.5% [69mmol/mol]) or those with ongoing problematic hypoglycaemia despite optimised multiple injection therapy. Observational data also confirm that the benefits seen in studies are realised in clinical practice . However, these data hide a proportion of patients who do not seem to receive benefit, or who fail to sustain it.…”

A Type 1 diabetes technology pathway: consensus statement for the use of technology in Type 1 diabetes

“…The NICE guidance and cost-benefit analysis was based on the CORE model, and assumed a baseline HbA 1c level of 72.7 mmol/mol (8.8%) and a reduction of 9.8 mmol/mol (0.9%). Interestingly, data from large UKbased audits of CSII demonstrate similar reductions in these scenarios [11,12,30].…”

“…Data from these registries offer real-world insights into factors associated with greater achievement of glucose targets. Indeed, both CSII and CGM have a large body of randomized controlled trial (RCT) as well as real-world observational evidence demonstrating benefits to people with Type 1 diabetes in terms of improved HbA 1c , reduced hypoglycaemia and improved quality of life [8,[10][11][12][13][14][15]. Indeed, both CSII and CGM have a large body of randomized controlled trial (RCT) as well as real-world observational evidence demonstrating benefits to people with Type 1 diabetes in terms of improved HbA 1c , reduced hypoglycaemia and improved quality of life [8,[10][11][12][13][14][15].…”

“…One of these is the fact that those achieving target HbA 1c values are far more likely to be using technology such as continuous glucose monitoring (CGM) or continuous subcutaneous insulin infusion (CSII) with an insulin pump [3,8,9]. Indeed, both CSII and CGM have a large body of randomized controlled trial (RCT) as well as real-world observational evidence demonstrating benefits to people with Type 1 diabetes in terms of improved HbA 1c , reduced hypoglycaemia and improved quality of life [8,[10][11][12][13][14][15].…”