Abstract
ObjectiveTo compare rates of microvascular complications in adolescents with type 1 diabetes treated with continuous subcutaneous insulin infusion (CSII) versus multiple daily injections (MDI).Research Design and MethodsProspective cohort of 989 patients (aged 12–20 years; diabetes duration >5 years) treated with CSII or MDI for >12 months. Microvascular complications were assessed from 2000–14: early retinopathy (seven-field fundal photography), peripheral nerve function (thermal and vibration threshold testing), autonomic nerve abnormality (heart rate variability analysis of electrocardiogram recordings) and albuminuria (albumin creatinine ratio/timed overnight albumin excretion). Generalized estimating equations (GEE) were used to examine the relationship between treatment and complications rates, adjusting for socio-economic status (SES) and known risk factors including HbA1c and diabetes duration.ResultsComparing CSII with MDI: HbA1C was 8.6% [70mmol/mol] vs. 8.7% [72 mmol/mol]) (p = 0.7), retinopathy 17% vs. 22% (p = 0.06); microalbuminuria 1% vs. 4% (p = 0.07), peripheral nerve abnormality 27% vs. 33% (p = 0.108) and autonomic nerve abnormality 24% vs. 28% (p = 0.401). In multivariable GEE, CSII use was associated with lower rates of retinopathy (OR 0.66, 95% CI 0.45–0.95, p = 0.029) and peripheral nerve abnormality (OR 0.63, 95% CI 0.42–0.95, p = 0.026), but not albuminuria (OR 0.46, 95% CI 0.10–2.17, p = 0.33). SES was not associated with any of the complication outcomes.ConclusionsIn adolescents, CSII use is associated with lower rates of retinopathy and peripheral nerve abnormality, suggesting an apparent benefit of CSII over MDI independent of glycemic control or SES.
Highlights
Continuous subcutaneous insulin infusion (CSII) therapy has been used to treat diabetes since the late 1970s [1,2,3]
In multivariable Generalized estimating equations (GEE), CSII use was associated with lower rates of retinopathy and peripheral nerve abnormality, but not albuminuria
CSII use is associated with lower rates of retinopathy and peripheral nerve abnormality, suggesting an apparent benefit of CSII over multiple daily insulin injections (MDI) independent of glycemic control or socio-economic status (SES)
Summary
Continuous subcutaneous insulin infusion (CSII) therapy has been used to treat diabetes since the late 1970s [1,2,3]. Comparing CSII with MDI: HbA1C was 8.6% [70mmol/mol] vs 8.7% [72 mmol/mol]) (p = 0.7), retinopathy 17% vs 22% (p = 0.06); microalbuminuria 1% vs 4% (p = 0.07), peripheral nerve abnormality 27% vs 33% (p = 0.108) and autonomic nerve abnormality 24% vs 28% (p = 0.401).
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