Abstract
Background: We aimed to assess the long-term effects of the introduction of continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) in people with type 1 diabetes (T1D). Methods: A prospective single-centre cohort study including participants with T1D and HbA1c > 7.5%. After completing a course in flexible intensified insulin treatment (FIT), participants were offered treatment change to CSII/CGM. FIT participants with HbA1c ≤ 7.5% who remained on multiple daily injections (MDI) and without CGM were monitored as a separate cohort to compare the cumulative incidence of diabetic complications. Results: The study cohort included 41 participants with T1D (21 male/20 female). The mean age (±SD) at inclusion was 24.2 ± 10.9 years, the mean follow-up was 8.9 ± 2.8 years, and the mean diabetes duration at the end of the study was 15.9 ± 10.1 years. The mean HbA1c level before the introduction of CSII was 8.8 ± 1.3% (73 ± 8 mmol/mol), and decreased significantly thereafter to 8.0 ± 1.1% (63 ± 7 mmol/mol) (p = 0.0001), and further to 7.6 ± 1.1% (59 ± 11 mmol/mol) after the initiation of CGM (p = 0.051). In the MDI group the HbA1c levels did not change significantly during a mean follow-up of 6.8 ± 3.2 years. The frequency of severe hypoglycaemia after the introduction of CSII/CGM declined significantly (from 9.7 to 2.2 per 100 patient-years, p = 0.03), and the cumulative incidence of newly diagnosed diabetic microvascular complications were comparable between the study group and the observational cohort. Conclusion: In people with T1D and unsatisfactory diabetes control the introduction of CSII and CGM results in a substantial and long-term improvement.
Highlights
In patients with type 1 diabetes mellitus (T1D), the objectives of intensified insulin treatment regimens are twofold, i.e., to achieve strict glycemic control in order to minimize the risk of secondary diabetic complications, and to avoid severe hypoglycemia and ketoacidosis to attain the best possible quality of life [1,2,3].Intensive insulin treatment aims at mimicking physiological insulin secretion patterns by means of multiple daily injections (MDI) of long-acting basal insulin and short-acting bolus insulin or via continuous subcutaneous insulin infusion (CSII) guided by frequent measurements of blood glucose either by self-monitoring (SMBG) or by continuous glucose monitoring systems (CGMS) [4]
There are a number of studies describing the effects of CSII on diabetes management and outcomes [8]
A retrospective trial from Sweden including 272 type 1 diabetes participants treated with CSII showed a significant and persistent reduction of the HbA1c of 0.20% (2.17 mmol/mol) over 5.5 years compared with controls
Summary
Intensive insulin treatment aims at mimicking physiological insulin secretion patterns by means of multiple daily injections (MDI) of long-acting basal insulin and short-acting bolus insulin or via continuous subcutaneous insulin infusion (CSII) (insulin pump therapy) guided by frequent measurements of blood glucose either by self-monitoring (SMBG) or by continuous glucose monitoring systems (CGMS) [4]. We aimed to assess the long-term effects of the introduction of continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) in people with type 1 diabetes (T1D). FIT participants with HbA1c ≤ 7.5% who remained on multiple daily injections (MDI) and without CGM were monitored as a separate cohort to compare the cumulative incidence of diabetic complications. The frequency of severe hypoglycaemia after the introduction of CSII/CGM declined significantly (from 9.7 to 2.2 per 100 patient-years, p = 0.03), and the cumulative incidence of newly diagnosed diabetic microvascular complications were comparable between the study group and the observational cohort. Conclusion: In people with T1D and unsatisfactory diabetes control the introduction of CSII and CGM results in a substantial and long-term improvement
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