Insulin pump therapy in youths with Type 1 diabetes: uptake and outcomes in the ‘real world’

Shulman, Rayzel; Palmert, Mark R.; Daneman, Denis

doi:10.2217/dmt.12.1

Cited by 12 publications

(29 citation statements)

References 39 publications

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“…This may explain why diabetes outcomes are similar in those using pump therapy and multiple daily insulin injection regimens . Despite equivocal data about comparative effectiveness, pump use is increasing and it is uncommon for patients to revert from pump therapy back to injections . As we have shown through qualitative research, pump therapy is valued by physicians for its status as a new technology, as a promising step in developing future technology, and for its role within a therapeutic relationship .…”

mentioning

confidence: 98%

“…However, most people using pumps do not frequently re‐evaluate and adjust insulin dose settings necessary for optimal management of T1D . This may explain why diabetes outcomes are similar in those using pump therapy and multiple daily insulin injection regimens . Despite equivocal data about comparative effectiveness, pump use is increasing and it is uncommon for patients to revert from pump therapy back to injections .…”

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confidence: 99%

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Insulin pump use and discontinuation in children and teens: a population-based cohort study in Ontario, Canada

et al. 2016

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confidence: 98%

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confidence: 99%

Insulin pump use and discontinuation in children and teens: a population-based cohort study in Ontario, Canada

et al. 2016

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“… 1 Pediatric pump use has become increasingly popular and it is uncommon for patients to revert to injections. 2–4 Ontario has a population of over 13 million and one of the highest incidences of type 1 diabetes in the world (>20/100 000/year). 5 The Ontario Pediatric Diabetes Network, comprised of 35 centers, oversees pediatric diabetes care.…”

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confidence: 99%

Low socioeconomic status is associated with adverse events in children and teens on insulin pumps under a universal access program: a population-based cohort study

Shulman

Stukel

Miller

et al. 2016

BMJ Open Diab Res Care

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ObjectiveTo describe adverse events in pediatric insulin pump users since universal funding in Ontario and to explore the role of socioeconomic status and 24-hour support.Research design and methodsPopulation-based cohort study of youth (<19 years) with type 1 diabetes (n=3193) under a universal access program in Ontario, Canada, from 2006 to 2013. We linked 2012 survey data from 33 pediatric diabetes centers to health administrative databases. The relationship between patient and center-level characteristics and time to first diabetic ketoacidosis (DKA) admission or death was tested using a Cox proportional hazards model and the rate of diabetes-related emergency department visits and hospitalizations with a Poisson model, both using generalized estimating equations.ResultsThe rate of DKA was 5.28/100 person-years and mortality 0.033/100 person-years. Compared with the least deprived quintile, the risk of DKA or death for those in the most deprived quintile was significantly higher (HR 1.58, 95% CI 1.05 to 2.38) as was the rate of diabetes-related acute care use (RR 1.60, 95% CI 1.27 to 2.00). 24-hour support was not associated with these outcomes. Higher glycated hemoglobin, prior DKA, older age, and higher nursing patient load were associated with a higher risk of DKA or death.ConclusionsThe safety profile of pump therapy in the context of universal funding is similar to other jurisdictions and unrelated to 24-hour support. Several factors including higher deprivation were associated with an increased risk of adverse events and could be used to inform the design of interventions aimed at preventing poor outcomes in high-risk individuals.

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“…In both groups, their HbA1c remained below the entry level throughout the course of the study. Shulman et al (2012) in a systematic review of the literature observed that while HbA1c levels frequently improve in the first year of treatment, they then trend back toward baseline levels (10). However, it should be noted that the number of participants in each group was relatively small by the 48-month point.…”

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confidence: 99%

Initiation of insulin pump therapy in children at diagnosis of type 1 diabetes resulted in improved long-term glycemic control

Lang¹,

King

Miller

et al. 2016

Pediatr Diabetes

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Insulin pump therapy in youths with Type 1 diabetes: uptake and outcomes in the ‘real world’

Cited by 12 publications

References 39 publications

Insulin pump use and discontinuation in children and teens: a population-based cohort study in Ontario, Canada

Insulin pump use and discontinuation in children and teens: a population-based cohort study in Ontario, Canada

Low socioeconomic status is associated with adverse events in children and teens on insulin pumps under a universal access program: a population-based cohort study

Initiation of insulin pump therapy in children at diagnosis of type 1 diabetes resulted in improved long-term glycemic control

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