Treatment satisfaction and glycemic control in young Type 1 diabetic patients in transition from pediatric health care: CSII versus MDI

Abstract

To evaluate whether continuous subcutaneous insulin infusion (CSII) may have any advantage over multiple daily injections (MDI) on glycemic control and treatment satisfaction in young patients with Type 1 diabetes in transition to an adult diabetes center. The study population consisted of 125 patients on MDI; 38 out of the 43 patients considered eligible for CSII completed the study and the 82 remaining on MDI served as control group. Glycemic control and treatment satisfaction [diabetes treatment satisfaction questionnaire (DTSQ)] were evaluated in all patients at baseline and after 12 weeks. At baseline, the two groups were well matched for demographic characteristics and glycemic control. DTSQ score was lower in CSII group (21.1 ± 8.8 vs. 25.1 ± 7.1, P = 0.011). After 12 weeks, a similar decrease in HbA1C was observed in both groups [difference -0.3 % (95 % CI-0.6 to 0.1, P = 0.847)]. Mean amplitude glucose excursions,blood glucose standard deviation, and overall hypoglycemia were significantly reduced in CSII group. DTSQ overall score increased in CSII and decreased in MDI (difference between groups = 9.9, 95 % CI 8.0-12.0, P<0.001), while perceived hyperglycemia and hypoglycemia decreased in CSII compared with MDI (difference:-2.5 and -2.0, respectively, P<0.001 for both). Among young Type 1 diabetic patients in transition from Pediatrics,CSII showed a similar efficacy in reducing HbA1c compared with MDI, with less hypoglycemia and glycemic excursions, and was better in improving overall treatment satisfaction and the rate of perceived hyperglycemia and hypoglycemia.

Technology Use in Transition-Age Patients With Type 1 Diabetes

“…Evidence points to a more successful transfer of care during the transition-age in patients using technology for insulin delivery and glucose monitoring (insulin pumps and CGM). [47][48][49] Larger randomized controlled trials are still needed to define patients that would most benefit from intervention, potential risks in relying on and promoting technology, and barriers to care needing to be addressed. 2.…”

Comparative study on treatment satisfaction and health perception in children and adolescents with type 1 diabetes mellitus on multiple daily injection of insulin, insulin pump and sensor-augmented pump therapy

“…4 The observation of improved treatment satisfaction can be seen with or without improved quality of life and the overall treatment satisfaction in diabetes management appears to be related to the method used for treatment. 5,6 …”

A Systematic Review of Transitional Care for Emerging Adults with Diabetes

“…Emerging adults who are using an infusion pump for diabetes care perceive greater control of their diabetes than those using multiple injections (p<0.001); however, episodes of hyperglycemia and hypoglycemia do not differ between these groups (Maiorino et al, 2014). The type of adult provider the emerging adult chose did have an effect on post-transition outcomes.…”