Association Between Management of Continuous Subcutaneous Basal Insulin Administration and HbA1C

Abstract

Background: While we expect that patients who adjust their insulin delivery algorithms between clinic visits to have better glucose control compared to those who do not, this effect has not been quantified. Method: This is a single-center retrospective cohort study including pediatric and adult patients with type 1 diabetes evaluating insulin pump self-management behaviors. Basal insulin dose information was obtained from the Glooko-Diasend database, and used to quantify the frequency and magnitude of basal insulin daily dose adjustments within the 90-day window preceding HbA1c measurement. We use a linear mixed-effects model to analyze associations between frequency/magnitude of daily basal insulin changes and HbA1c. Results: We present data on 114 adult (44 ± 17 years, 60% female) and 212 pediatric (12 ± 4 years, 50% female) patients. Individuals changed their basal insulin dose on 72%-94% (interquartile range [IQR]) of observed days relative to the previous day. These changes varied 0.6%-2.4% IQR from the previous day’s value. In pediatric patients, lower HbA1c was associated with more frequent daily profile adjustments, while controlling for rate of hypoglycemia (z = -3.2, P = .001). In adults, there was no relationship between HbA1c and magnitude or frequency of basal profile adjustments. Conclusions: Pediatric patients who frequently modify their basal insulin exhibit somewhat better clinical outcomes, although the magnitude by which their basal amount is changed does not contribute to this effect.

Associations between insulin pump self‐management and HbA1c in type 1 diabetes

“…In our questionnaire‐based study, focusing on long‐lasting insulin delivery adjustment in both bolus calculator and basal rate settings, we found a clear association between user‐driven adjustments and lower HbA1c. Taken together, ours and others’ 19 results suggest that interventions aimed at educating and empowering users in adjusting insulin pump settings could add to improved glycaemic control. However, before designing interventions, it would be relevant to investigate more closely the characteristics of those users who take responsibility for insulin pump settings adjustments, as well as the ones who never adjust settings.…”

“…No distinction was made between temporary basal, suspensions and long‐lasting basal profile changes, and only individuals who adhered to certain treatment recommendations and uploaded regularly were included. The authors found frequent basal rate changes by the pump users or the parents to be associated with significantly lower HbA1c in the paediatric population, but this was not the case in the adult group 19 . In our questionnaire‐based study, focusing on long‐lasting insulin delivery adjustment in both bolus calculator and basal rate settings, we found a clear association between user‐driven adjustments and lower HbA1c.…”

“…The authors found frequent basal rate changes by the pump users or the parents to be associated with significantly lower HbA1c in the paediatric population, but this was not the case in the adult group. 19 In our questionnaire-based study, focusing on long-lasting insulin delivery adjustment in both bolus calculator and basal rate settings, we found a clear association between user-driven adjustments and lower HbA1c. Taken together, ours and others' 19 results suggest that interventions aimed at educating and empowering users in adjusting insulin pump settings could add to improved glycaemic control.…”

“…This topic, proactive management of pump profile settings in between visits, was also addressed in a retrospective cohort study including children and adults with type 1 diabetes. 19 In that study, the association between HbA1c, and frequency and magnitude of basal insulin daily dose adjustments, was investigated using data from the Glooko-Diasend platform. No distinction was made between temporary basal, suspensions and long-lasting basal profile changes, and only individuals who adhered to certain treatment recommendations and uploaded regularly were included.…”

“…In our study, user‐driven adjustment of insulin pump settings was the factor with the largest association with HbA1c. This topic, proactive management of pump profile settings in between visits, was also addressed in a retrospective cohort study including children and adults with type 1 diabetes 19 . In that study, the association between HbA1c, and frequency and magnitude of basal insulin daily dose adjustments, was investigated using data from the Glooko‐Diasend platform.…”