Factors associated with withdrawal from insulin pump therapy: A large‐population‐based study

Abstract

Background: Although, number of diabetic patients received insulin pump (IP) therapy is increasing; there are limited data regarding factors associated with IP withdrawal.Methods: We conducted a cross-sectional study using data from an Israeli health maintenance organization. All patients, 21 or older, with type 1 (T1DM) or type 2 (T2DM) diabetes, who received IP therapy for a 7-year period were identified.Patients who did not purchase IP maintenance supplies for at least six consecutive months were defined as withdrawn (N = 355). Patients who purchased supplies were defined as adherent (N = 352). Results: In both T1DM and T2DM patients, withdrawal from IP therapy was positively associated with duration of diabetes longer than 5 years (odds ratio [OR] = 13.26 [CI, 7.16-23.34; P < .001] and OR = 10.92 [CI, 5.64-21.14; P < .001], respectively), nonadherence to dietician follow-up (OR = 5.78 [CI, 3.65-9.14; P < .001] and OR = 3.41 [CI, 1.99-5.85; P < .001], respectively), and poor glycaemic control prior to IP treatment (OR = 4.04 [CI, 2.18-7.48; P < .001] and OR = 4.59 [CI, 2.71-7.81; P < .001], respectively]. Co-morbid neuro-psychiatric disorders were also risk factors for IP withdrawal: diagnosis of depression (OR = 2.22 [CI, 1.16-4.27; P = .017] and Attention Deficit Hyperactivity Disorder (ADHD) OR = 2.45 [CI, 1.003-5.087; P = .043]) among T1DM patients; and diagnosis of depression (OR = 1.85 [CI, 1.05-5.27; P = .046] and dementia OR = 4.03 [CI, 1.03-19.77; P = .048]) among T2DM patients. Conclusion: In our large real-world population-based study, we found that smoking, obesity, poor glycaemic control, and co-morbid neuro-psychiatric disorders were associated with a high rate of withdrawal from IP therapy. Health care providers ought to familiarize themselves with patient characteristics predictive of nonadherence and should intensify patient follow-up when incorporating this new, costly, and challenging technology. K E Y W O R D S diabetes mellitus, insulin pump, nonadherence

Glycemic Control and Diabetes Related Complications in Adults with Type 1 Diabetes Mellitus and ADHD

“…Thus, children with co-morbid ADHD and T1DM have poorer glycemic control and a higher incidence of short-term complications including higher HbA 1 C levels, hypoglycemia and diabetic ketoacidosis (DKA), higher rates of withdrawal from insulin pump (IP) therapy, more emergency-room (ER) admissions, longer hospitalizations, and higher medical costs (Hilgard et al, 2017; Vinker-Shuster et al, 2019). ADHD was also related to higher rate of IP withdrawal among young adults with T1DM (Merzon et al, 2020). To our knowledge, the magnitude of research on the interaction of ADHD and T1DM focused on pediatric patients and young adults, and data regarding long term T1DM complications among ADHD patients is scarce.…”

Patient-level predictors of temporal regularity of primary care visits

“…These LHS care coordination initiatives are built into the LHS electronic medical record and are supported by frequent events for providers and other kinds of administrative support [ 26 , 27 ]. The LHS initiative to support care for diabetes mellitus is particularly strong and longstanding [ 25 , 44 ], and there are a large number of quality measures for patients with diabetes that may encourage more regular contact with the health system [ 43 ]. This may have contributed to our finding of more temporally regular visits among patients with diabetes mellitus.…”

Non-mental diseases associated with ADHD across the lifespan: Fidgety Philipp and Pippi Longstocking at risk of multimorbidity?

“…Such an effect could potentially mask DM-induced blood glucose changes, hindering timely intervention, and therefore further studies should aim to clarify whether ADHD stimulant-based medication can alter blood glucose concentration. Additionally, there are studies showing that comorbid ADHD leads to a poorer glycemic control in adolescents with T1DM as well to a poorer adherence to insulin pump therapy in adults (Macek et al, 2019;Merzon et al, 2020).…”