Insulin Pump Therapy Is Associated with Lower Rates of Retinopathy and Peripheral Nerve Abnormality

Abstract

ObjectiveTo compare rates of microvascular complications in adolescents with type 1 diabetes treated with continuous subcutaneous insulin infusion (CSII) versus multiple daily injections (MDI).Research Design and MethodsProspective cohort of 989 patients (aged 12–20 years; diabetes duration >5 years) treated with CSII or MDI for >12 months. Microvascular complications were assessed from 2000–14: early retinopathy (seven-field fundal photography), peripheral nerve function (thermal and vibration threshold testing), autonomic nerve abnormality (heart rate variability analysis of electrocardiogram recordings) and albuminuria (albumin creatinine ratio/timed overnight albumin excretion). Generalized estimating equations (GEE) were used to examine the relationship between treatment and complications rates, adjusting for socio-economic status (SES) and known risk factors including HbA1c and diabetes duration.ResultsComparing CSII with MDI: HbA1C was 8.6% [70mmol/mol] vs. 8.7% [72 mmol/mol]) (p = 0.7), retinopathy 17% vs. 22% (p = 0.06); microalbuminuria 1% vs. 4% (p = 0.07), peripheral nerve abnormality 27% vs. 33% (p = 0.108) and autonomic nerve abnormality 24% vs. 28% (p = 0.401). In multivariable GEE, CSII use was associated with lower rates of retinopathy (OR 0.66, 95% CI 0.45–0.95, p = 0.029) and peripheral nerve abnormality (OR 0.63, 95% CI 0.42–0.95, p = 0.026), but not albuminuria (OR 0.46, 95% CI 0.10–2.17, p = 0.33). SES was not associated with any of the complication outcomes.ConclusionsIn adolescents, CSII use is associated with lower rates of retinopathy and peripheral nerve abnormality, suggesting an apparent benefit of CSII over MDI independent of glycemic control or SES.

ISPAD Clinical Practice Consensus Guidelines 2018: Diabetes technologies

“…Yet, the RCT studies that have not shown a lowering of HbA1c have highlighted the endorsement of pump therapy as patients randomized to the technology continued its use by the end of the study, had higher reports of treatment satisfaction, and reported decreased diabetes‐related worry . Interestingly, prospective examination of nearly 1000 patients either on pump or MDI therapy found that despite similar HbA1c levels attained, lower rates of retinopathy and peripheral nerve abnormality were noted in the insulin pump treated group . Furthermore, data from meta‐analyses conducted by various groups have depicted similar findings with pump therapy.…”

Persistent heterogeneity in diabetes technology reimbursement for children with type 1 diabetes: The SWEET perspective

“…CSII allows the administration of lower doses of insulin, lowering of the HbA1c without inducing a higher risk of hypoglycemia, and greater flexibility in eating habits and physical activity . Moreover, it was shown that CSII therapy reduces chronic diabetes complications in comparison with MDI, despite them having similar HbA1c . Despite the confirmed effects of insulin pump therapy, this technology is still not available in two European countries, and significant burdens in CSII accessibility were reported for seven others.…”

Physiological factors influencing diabetes control in type 1 diabetes children with insulin pumps from diagnosis

“…Children on insulin pumps present lower glycaemic variability and a lower glycaemic profile compared with those using MDI . Treatment with CSII is also associated with lower rates of retinopathy and peripheral nerve abnormality in adolescents . Further, this kind of therapy is associated with a considerable reduction in the risk of fatal coronary heart disease, fatal cardiovascular disease, and all causes of mortality .…”

“…9 Treatment with CSII is also associated with lower rates of retinopathy and peripheral nerve abnormality in adolescents. 10 Further, this kind of therapy is associated with a considerable reduction in the risk of fatal coronary heart disease, fatal cardiovascular disease, and all causes of mortality. 11 Additionally, use of CSII from the onset of diabetes improves treatment satisfaction.…”