Metabolic control and hypoglycaemia in people with type 1 diabetes: insulin pump therapy vs. intensified insulin therapy in an unselected cohort in routine care

Guido Kramer,Ulrich A Müller,Christof Kloos,Nadine Kuniss,Gunter Wolf

doi:10.1186/s13098-021-00700-0

Abstract

AimsThe aim of this study was to compare individuals with type 1 diabetes with continuous subcutaneous insulin infusion (CSII) and intensified insulin therapy (ICT) in routine care regarding metabolic control and treatment satisfaction.MethodsIndividuals with type 1 diabetes (CSII n = 74; ICT n = 163) were analysed regarding metabolic control, frequency of hypoglycaemia and treatment satisfaction (DTSQs range 0–36).ResultsIndividuals with CSII (duration of CSII: 14.1 ± 7.2 years) were younger (51.1 ± 15.8 vs. 56.2 ± 16.2 years, p = 0.023), had longer diabetes duration (28.7 ± 12.4 vs. 24.6 ± 14.3 years, p = 0.033), lower insulin dosage (0.6 ± 0.2 vs. 0.7 ± 0.4 IU/kg, p = 0.004), used more frequently short-acting analogue insulin (90.5% vs. 48.5%, p < 0.001) and flash/continuous glucose monitoring (50.0% vs. 31.9%, p = 0.009) than people with ICT. HbA1c was similar between CSII and ICT (7.1 ± 0.8%/54.4 ± 9.1 mmol/mol vs. 7.2 ± 1.0%/55.7 ± 10.9 mmol/mol, p = 0.353). Individuals with CSII had higher frequency of non-severe hypoglycaemia per week (in people with blood glucose monitoring: 1.9 ± 1.7 vs. 1.2 ± 1.6, p = 0.014; in people with flash/continuous glucose monitoring: 3.3 ± 2.2 vs. 2.1 ± 2.0, p = 0.006). Prevalence of polyneuropathy (18.9% vs. 38.0%, p = 0.004) and systolic blood pressure (138.0 ± 16.4 vs. 143.9 ± 17.1 mmHg, p = 0.014) was lower in CSII. Satisfaction with diabetes treatment (26.7 ± 7.3 vs. 26.0 ± 6.8, p = 0.600) did not differ between CSII and ICT.ConclusionsCSII and ICT yielded comparable metabolic control and treatment satisfaction but CSII was associated with higher incidence of non-severe hypoglycaemia and lower insulin dosage.

Highlights

IntroductionIntensified insulin therapy (ICT) and insulin pump therapy (continuous subcutaneous insulin infusion; CSII) are the most common insulin therapies for people with type
Intensified insulin therapy (ICT) and insulin pump therapy are the most common insulin therapies for people with type1 diabetes
Study participants with continuous subcutaneous insulin infusion (CSII) had a lower dose of total insulin (0.6 ± 0.2 vs. 0.7 ± 0.4 IU/kg, p = 0.004) whereas the dose of basal insulin was comparable between CSII and ICT (0.3 ± 0.1 vs. 0.3 ± 0.2 IU/kg, p = 0.591)

Summary

Introduction

Intensified insulin therapy (ICT) and insulin pump therapy (continuous subcutaneous insulin infusion; CSII) are the most common insulin therapies for people with type. Conventional insulin therapy (CT) with two daily injections of premixed insulin is used in individuals with type 1 diabetes only in exceptional circumstances. ICT is characterised with multiple injections of short acting human/analogue insulin as well as long/intermediate acting insulin (basal insulin) once or twice daily (“insulin pen therapy”). Only short acting human/analogue insulin is used for CSII. An. Kramer et al Diabetol Metab Syndr (2021) 13:80 insulin pump is a small, computerised device that continuously delivers small insulin doses for basal requirements (hourly basal rate). An insulin pump consists of a control module, an insulin reservoir and an infusion set that includes a cannula and tubing system. A variety of pump systems from different manufacturers is available on the market

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