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

Abstract

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...

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

“…The mean difference in HbA 1c in our cohort was greater at -1.1% after 5 years, consistent with a higher baseline HbA 1c of 78 mmol/mol (9.3%) compared with the Beato-Vibora study baseline HbA 1c of 70 mmol/mol (8.6%) [4]. 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 [13], a sustained reduction in HbA 1c of -0.6% in Slovenia [14] and a 5-year reduction of -0.5% in two large studies in France [15,16]. Meanwhile, a Swedish study showed a modest -0.2% change in in HbA 1c in 331 patients after 5 years [17], 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 [18].…”

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

“…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%.…”

Efficacy of Insulin Pump Therapy in Elderly Patients

“…Large insulin pump audits conducted worldwide have shown that the mean ages of patients treated with CSII were younger, between 34 and 39 (SD 10-14) years, than those on multiple daily insulin injections. 9,10 Although this may represent the greater use of CSII in the pediatric population, it may also suggest that use is being limited in older patients. Therein lies a particularly vulnerable population of patients with increased risks of hypoglycemia and IAH, who may benefit from CSII, but for whom access to this technology may be limited by cognitive function, by manual dexterity, and potentially by healthcare professional attitudes.…”