Long-Term Metabolic Effects of Continuous Subcutaneous Insulin Infusion Therapy in Type 1 Diabetes

Cohen, Neale; Hong, Eui Sil; Drie, Christy Van; Balkau, Beverley; Shaw, Jonathan E.

doi:10.1089/dia.2012.0331

Cited by 21 publications

(21 citation statements)

References 18 publications

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“…In some published studies, the benefits of CSII either were lost or were minimal at 3-5 years of follow-up [18][19][20]. By contrast, we observed benefits of CSII on HbA 1c for up to 10 years of follow-up.…”

Section: Previous Studies Relating Hba 1c Change To Duration Of Csii contrasting

confidence: 65%

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

et al. 2017

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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.

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Section: Previous Studies Relating Hba 1c Change To Duration Of Csii contrasting

confidence: 65%

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

et al. 2017

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“…Other European centres have shown variable results with reductions in HbA 1c of –0.6% to –0.9%, including a reduction in HbA 1c that was not sustained beyond 3 years in Spain , a sustained reduction in HbA 1c of –0.6% in Slovenia and a 5‐year reduction of –0.5% in two large studies in France . Meanwhile, a Swedish study showed a modest –0.2% change in in HbA 1c in 331 patients after 5 years , and a smaller Australian study of 126 CSII users had a significant improvement in HbA 1c of –0.64% at 6 months that was sustained to 3 years . These variable findings are likely attributed to differences in demographics, clinical practice and guidelines, follow‐up frequency, and access to structured education.…”

Section: Discussionmentioning

confidence: 99%

Continuous subcutaneous insulin infusion (CSII) therapy at Derby Teaching Hospitals: sustained benefits in glucose control

et al. 2017

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“…[2][3][4][5] Recent retrospective studies have reported the long-term efficacy and safety of CSII in adult and younger patients, but quality of life and satisfaction were not questioned in these studies. [11][12][13] The design of our study included data collection on CSII utilization and satisfaction. We observed that patients with CSII had a high level of satisfaction several years after CSII initiation and were prone to encourage their peers to move to pump therapy.…”

Section: Discussionmentioning

confidence: 99%

Cross-sectional Survey and Retrospective Analysis of a Large Cohort of Adults With Type 1 Diabetes With Long-Term Continuous Subcutaneous Insulin Infusion Treatment

Joubert

Morera

Vicente

et al. 2014

J Diabetes Sci Technol

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Continuous subcutaneous insulin infusion (CSII) is an established modality for treating type 1 diabetes (T1D) when the HbA1c level persistently remains above 7.5% despite the intensification of health care by a multidisciplinary team and optimization of the patient's education.1 When compared to multiple daily injections (MDI), CSII allows an equal or lower HbA1c level with fewer mild and severe cases of hypoglycemia.2-5 Most studies on CSII utilization in T1D were prospective and were conducted from several weeks' to 2 years' duration.2 Few retrospective studies have questioned the long-term benefit of CSII utilization, and long-term evaluations of satisfaction and quality of life are scarce.6-13 The present cross-sectional survey and retrospective analysis of a cohort of patients with T1D treated by CSII gives the opportunity to evaluate the long-term tolerance and satisfaction of the device and the therapeutic behavior of CSII users in reallife conditions. Safety and efficacy issues are also under the scope of this study. MethodsThis single-center retrospective study and trans-sectional survey was conducted by the endocrinology department from a French university hospital. The study enrolled patients with T1D using CSII for more than 1 year from January 1999 (year of reimbursement of CSII treatment by the French National Health System) until December 2008. Insulin pumps used in our center during this period of time were Medtronic 508, 511, 512, and 515 (Medtronic, Minneapolis, AbstractBackground. Continuous subcutaneous insulin infusion (CSII) is an established modality for intensive insulin treatment of type 1 diabetes (T1D), but long-term data concerning satisfaction, CSII function use, safety, and efficacy in real-life conditions are scarce. Methods. We analyzed a cohort of adult patients with T1D treated with CSII for more than 1 year in a single diabetes center. We performed a cross-sectional survey in 2010 (tolerance/satisfaction and behavior forms) and a retrospective analysis of medical records (including HbA1c level, hospitalization, and catheter infections). The primary objective was to assess long-term tolerance/satisfaction, and secondary objectives were safety and efficacy. Results. There were 295 patients analyzed. After a median duration of CSII use of 5 years, overall satisfaction was high for about 90% of patients. Mean CSIIrelated discomfort scores were low for work, recreation, and sleep and moderate for sport and sexual activity (2.5 ± 1.9, 2.6 ± 1.8, 2.6 ± 2.1, 3.4 ± 2.3, and 4.0 ± 2.9 of 10, respectively). Despite a high level of diabetes education, only one third of patients were using advanced CSII functions. During long-term follow-up, the safety of CSII treatment was good; the hospitalization rate was 0.18 patients/year, and catheter infections were scarce. The HbA1c level dropped about -0.5% independently from CSII duration (P < .05). Conclusions. In this adult cohort, satisfaction and tolerance, together with safety, of CSII were maintained at long-term follow up. The sole basic f...

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Long-Term Metabolic Effects of Continuous Subcutaneous Insulin Infusion Therapy in Type 1 Diabetes

Abstract: CSII in type 1 diabetes is associated with improved glycemic control with no increase in hypoglycemia. HbA1c improvement declined over time, suggesting a need for re-education after CSII commencement. The iMDI program did not have significant glycemic benefits.

Cited by 21 publications

References 18 publications

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

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

Continuous subcutaneous insulin infusion (CSII) therapy at Derby Teaching Hospitals: sustained benefits in glucose control

Cross-sectional Survey and Retrospective Analysis of a Large Cohort of Adults With Type 1 Diabetes With Long-Term Continuous Subcutaneous Insulin Infusion Treatment

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