HbA1c variability in adults with type 1 diabetes on continuous subcutaneous insulin infusion (CSII) therapy compared to multiple daily injection (MDI) treatment

Abstract

ObjectiveTo determine if continuous subcutaneous insulin infusion (CSII) therapy is associated with lower glycated haemoglobin (HbA1c) variability (long-term glycaemic variability; GV) relative to multiple daily injection (MDI) treatment in adults with type 1 diabetes mellitus (T1DM).DesignRetrospective audit.Setting and participantsClinic records from 506 adults with T1DM from two tertiary Australian hospitals.Outcome measuresLong-term GV was assessed by HbA1c SD and coefficient of variation (CV) in adults on established MDI or CSII therapy, and in a subset changing from MDI to CSII.ResultsAdults (n=506, (164 CSII), 50% women, mean±SD age 38.0±15.3 years, 17.0±13.7 years diabetes, mean HbA1c 7.8%±1.2% (62±13 mmol/mol) on CSII, 8.0%±1.5% (64±16 mmol/mol) on MDI) were followed for 4.1±3.6 years. CSII use was associated with lower GV (HbA1c SD: CSII vs MDI 0.5%±0.41% (6±6 mmol/mol) vs 0.7%±0.7% (9±8 mmol/mol)) and CV: CSII vs MDI 6.7%±4.6% (10±10 mmol/mol) vs 9.3%±7.3% (14±13 mmol/mol), both p<0.001. Fifty-six adults (73% female, age 36±13 years, 16±13 years diabetes, HbA1c 7.8%±0.8% (62±9 mmol/mol)) transitioned from MDI to CSII. Mean HbA1c fell by 0.4%. GV from 1 year post-CSII commencement decreased significantly, HbA1c SD pre-CSII versus post-CSII 0.7%±0.5% (8±5 mmol/mol) vs 0.4%±0.4% (5±4 mmol/mol); p<0.001, and HbA1c CV 9.2%±5.5% (13±8 mmol/mol) vs 6.1%±3.9% (9±5 mmol/mol); p<0.001.ConclusionsIn clinical practice with T1DM adults relative to MDI, CSII therapy is associated with lower HbA1c GV.

Predictors of the Effectiveness of Insulin Pumps in Patients with Type 1 Diabetes Mellitus

“…Our results are in agreement with previous reports evidencing an improvement in HbA1c levels after start therapy with insulin pump [18,21,19]. The association of higher baseline HbA1c values with greater reduction of HbA1c is also in agreement with other studies [26].…”

Oral delivery of liraglutide-loaded Poly-N-(2-hydroxypropyl) methacrylamide/chitosan nanoparticles: Preparation, characterization, and pharmacokinetics

“…Diabetes is a metabolic disease brought about by a variety of factors, 1 manifested by insufficient insulin secretion or insulin resistance, which can cause sugar, fat, and protein metabolic disorders, as well as secondary metabolic disorders of water and electrolytes. 2,3 The occurrence of diabetes can be affected by genetic factors, however other factors can also cause diabetes. 4 Dietary habits, psychological factors, and social factors are also related to the occurrence of diabetes.…”

Imaging the eye and its relevance to diabetes care

“…In type 1 diabetes for the same level of HbA1c, the use of insulin pumps and/or continuous glucose monitors has already been associated with substantially lower rates of DR, other microvascular complications, CVD events, and mortality and severe hypoglycemia 67,68 . Potential mechanisms might relate to the lower dose of insulin required when delivered by an insulin pump versus multiple daily injections and potentially less glucose variability with pump delivery 69 , which might reduce inflammation, oxidative stress and epigenetic changes 70 . As chronic complications take years, indeed often decades, to develop, some of these ocular imaging and grading techniques could be used as surrogate end-points in clinical trials and, if merited, in clinical practice.…”