Availability of insulin pump therapy in clinical practice

Abstract

Aim To examine the availability of insulin pump therapy in patients with Type 1 diabetes.Methods Patients using insulin pumps among a cohort of 7224 patients with Type 1 diabetes were studied.Results In logistic regression, used to evaluate variables not changing over time among the total cohort, use of insulin pumps varied by outpatient clinic (P < 0.001) and sex (P < 0.001). Cox regression analysis in 5854 patients with detailed patient data prior to use of an insulin pump showed higher HbA 1c (P < 0.0001), lower creatinine (P = 0.002), high and low insulin doses (P < 0.0001), younger age (P < 0.0001) and female sex (P < 0.0001) to be associated with use of an insulin pump. Women were 1.5-fold more likely to start using an insulin pump (hazard ratio 1.52, 95% confidence interval 1.29-1.79) and patients in the 20-to 30-years age range were more than twice as likely to begin use of an insulin pump than patients aged 40-50 years (hazard ratio 8.63, 95% confidence interval 5.91-12.59 and hazard ratio 3.98, 95% confidence interval 2.80-5.64, respectively). A 10-lmol ⁄ l higher level of creatinine was associated with a hazard ratio of 0.56 (95% confidence interval 0.39-0.81) of starting use of an insulin pump.Conclusions At 10 hospital outpatient clinics in Sweden, use of insulin pumps therapy varied by clinic. A higher proportion of women began using insulin pumps. Younger patients and patients with fewer complications were also more likely to start using an insulin pump. Further research is needed to confirm these findings in other geographical regions and to understand whether the availability of insulin pumps today is optimized.

Pumps or Multiple Daily Injections in Pregnancy Involving Type 1 Diabetes: A Prespecified Analysis of the CONCEPTT Randomized Trial

“…Another possible explanation for the seemingly disappointing impact of pump therapy on maternal glycemia is that pumps may have been offered to women with more challenging diabetes. Realworld data suggest that insulin pump users have higher HbA 1c levels when starting pump therapy compared with non-pump users and are more likely to be female and aged 20-30 years (24). Although glycemic control measured both by HbA 1c and CGM (time in target, time above target, and glucose variability measures) were similar between the groups at the time of enrollment into CONCEPTT, this does not preclude previous differences at the time of pump therapy initiation.…”

Health‐economic analysis of real‐time continuous glucose monitoring in people with Type 1 diabetes

“…In 2012, it was reported that 18.7% of people with Type 1 diabetes in Sweden were using CSII , and may benefit from CGM. Given Swedish recommendations, it is assumed that these patients represent a subset of the Type 1 diabetes population who experience recurrent hypoglycaemic and hyperglycaemic events .…”

Low uptake of continuous subcutaneous insulin infusion therapy in people with type 1 diabetes in Ireland: a retrospective cross-sectional study.

“…The diversity in uptake of CSII between different age groups is common. Authors of the study conducted in Sweden concluded that people aged between 20-30 years were more than twice as likely to initiate use of CSII than those aged 40-50 years [34], and data from registries suggest that younger people with type 1 diabetes use CSII more often than older adults [15,26]. CSII is recommended by ISPAD as a preferred mode of treatment in the youngest population [1].…”