Variations in the quality and sustainability of long-term glycaemic control with continuous subcutaneous insulin infusion

• Published in: Diabetic medicine 2014-10, Vol.31 (10), p.1174-1177
• Main Authors: Nixon, R., Folwell, R., Pickup, J. C.
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Body Mass Index; Cohort Studies; Diabetes; Diabetes Mellitus, Type 1 - blood; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - drug therapy; Endocrinopathies; Feeding. Feeding behavior; Female; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Glycated Hemoglobin A - analysis; Humans; Hyperglycemia; Hyperglycemia - prevention & control; Hypoglycemia - prevention & control; Hypoglycemic Agents - administration & dosage; Hypoglycemic Agents - adverse effects; Hypoglycemic Agents - therapeutic use; Infusions, Subcutaneous; Insulin; Insulin - administration & dosage; Insulin - adverse effects; Insulin - therapeutic use; Insulin Infusion Systems - adverse effects; Insulin Resistance; London; Male; Medical sciences; Medication Adherence; Middle Aged; Outpatient Clinics, Hospital; Overweight - complications; Quality of Health Care; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/dme.12486

Aims To investigate the pattern of changes in HbA1c in people with Type 1 diabetes managed by long‐term Continuous subcutaneous insulin infusion. Methods We studied HbA1c changes using computerized clinic records in 35 adult people with Type 1 diabetes and an elevated HbA1c (≥ 64 mmol/mol, 8.0%) on multiple daily insulin injections, who were then switched to continuous subcutaneous insulin infusion for at least 5 years. Results We identified three subgroups with similar baseline HbA1c but different long‐term responses to pump therapy: group A—those with improvement followed by deterioration (57%); group B—those with improvement that was sustained throughout the 5 years (31%); and group C—those where HbA1c did not change significantly from baseline (12%). The patients in group C had a higher BMI: 31.0 ± 5.2 vs. 25.9 ± 3.3 vs. 25.2 ± 3.1 kg/m2 (group C vs. group A and group B; P = 0.02). Conclusions Improved glycaemic control with continuous subcutaneous insulin infusion was maintained over 5 years by 88% of people with Type 1 diabetes in this study, but there were variations in the long‐term efficacy, with some people improving and worsening, others maintaining strict control and a few subcutaneous insulin infusion ‘non‐responders’. What's new? This is the first study to investigate variations in HbA1c during long‐term continuous subcutaneous insulin infusion in those selected for elevated HbA1c at baseline. We identified three subgroups with different long‐term insulin pump efficacy: those with improvement followed by deterioration; those with improvement that was sustained throughout the 5 years; and those where HbA1c did not change significantly from baseline. Improved glycaemic control with continuous subcutaneous insulin infusion was maintained over 5 years by 88% of people, with only 12% non‐responders. Continuous subcutaneous insulin infusion ‘non‐responders’ were more likely to be overweight or obese