Insulin Pump Therapy Issues Among Adults with Type 1 Diabetes Mellitus in Saudi Arabia: A Retrospective Study

Abstract

Introduction: Type 1 diabetes mellitus (T1DM) is on the rise in Saudi Arabia. Management of T1DM is crucial in curbing the economic burden of this disease. Studies on insulin pump issues are scarce in the region. The present study aims to fill this gap. Methods: In this single-centre, retrospective study done in King Abdulaziz Medical City (KAMC) from March 2018 to March 2019, a total of 118 known Saudi T1DM adults (34 males and 84 females) were included. Data on demographics, glycated haemoglobin (HbA1c) and CSII use were collected. Results: The most common problem encountered by the patients on CSII was breaking down of the pump (30.0%), relocation of the cannula or tubing (22%) and air bubbles affecting delivery (16.1%). Eighty-one subjects (68.6%) claimed to have been admitted for DM management while on CSII. The use of CSII led to a significant reduction in HbA1c in all subjects (p \ 0.001), but levels remain suboptimal. Only 53 subjects (44.9%) reported no significant problems in their CSII experience. Conclusion: There is a high prevalence of T1DM adult patients experiencing device malfunctions and other issues while on CSII therapy. This may account for suboptimal improvement in the glycaemic control among T1DM Saudi patients. Issues on adherence and device malfunctions should be investigated further.

Air Bubbles in Insulin Pumps: A Clinically Relevant Issue?

“…Data about the prevalence of air bubbles are also mentioned in two other pump surveys. 9,10 A prevalence of 16% is reported in one survey and 46% in the other. Issues with such data are that the documentation of the rate of air bubble formation/size of air bubbles depends critically on the skills of the person making the assessment.…”

Knowledge and Practices of Insulin Pump among Adults with Type 1 Diabetes Attending a Specialized Center in Saudi Arabia

“…Reducing the risk of exercise-induced hypoglycemia can be achieved by frequent glucose monitoring and eating carbohydrates during exercise [24]. Lack of appropriate insulin pump maintenance can be manifested in several adverse events, such as pump failure, pain, adhesion, irritation, lipodystrophy, and technical issues [12,25]. It has been suggested that comprehensive patient education and frequent Blood Glucose Monitoring (SMBG or CGM) are necessary components of successful insulin pump therapy [8,14].…”

“…However, adverse events of insulin pump interfering with its function are still common despite the modern advances [9,10]. These include pump failure, blockage or dislocation of infusion set, infusion site infection or issues, and reduced insulin stability [11,12]. Additionally, successful insulin pump therapy is considerably influenced by adherence to self-care behaviors [13,14].…”

“…Despite having one of the world's highest rates of T1D [16], data about the prevalence of using insulin pump in Saudi Arabia are still lacking [12]. Most of the local studies focused on the impact of insulin pump on the glycemic control and acute complications [12,17,18].…”

“…Despite having one of the world's highest rates of T1D [16], data about the prevalence of using insulin pump in Saudi Arabia are still lacking [12]. Most of the local studies focused on the impact of insulin pump on the glycemic control and acute complications [12,17,18]. On the other hand, insulin pump related knowledge and practices among patients with T1D were not comprehensively examined in Saudi Arabia.…”