Prevalence of Insulin Pump Therapy and Its Association with Measures of Glycemic Control: Results from the Canadian Study of Longevity in Type 1 Diabetes
Restricted accessResearch articleFirst published online May, 2016
Prevalence of Insulin Pump Therapy and Its Association with Measures of Glycemic Control: Results from the Canadian Study of Longevity in Type 1 Diabetes
We aimed to determine cross-sectional insulin pump prevalence and factors associated with measures of glycemic control as a secondary analysis in a long-standing type 1 diabetes mellitus (T1DM) national cohort.
Research Design and Methods:
Canadian participants with ≥50 years of T1DM (n = 305) were administered a comprehensive mail-based questionnaire including acquisition of contemporaneous laboratory results. Factors associated with pump use, glycosylated hemoglobin (HbA1c), and hypoglycemia were analyzed by regression.
Results:
The 305 participants had a median age of 65 [interquartile range, 59, 71] years, median diabetes duration of 54 [51, 59] years, and mean HbA1c level of 7.5 ± 1.1%. Prevalence of pump use was 44% (133/305), with median duration of use 8 [4, 13] years. Compared with the non-pump subgroup, the pump subgroup had numerically lower but similar HbA1c levels (7.4 ± 0.9% vs. 7.6 ± 1.2%; P = 0.22) and reported greater numbers of minor hypoglycemia events (6.5 vs. 5.1 events/patient·month; P = 0.004) and fewer severe hypoglycemia events (0.5 vs. 1.3 events/patient·year; P = 0.02) in the past year. More frequent daily glucose tests and more frequent minor hypoglycemia events—but not pump therapy or its prescription parameters—were independently associated with lower HbA1c level in multivariable regression. However, use of insulin pump and habitual use of continuous glucose monitoring (≥1 week/month) were each independently associated with lower risk of severe hypoglycemia (risk ratio = 0.50 [P < 0.0001] and 0.30 [P = 0.001], respectively).
Conclusions:
Insulin pump and continuous glucose monitoring technologies were associated with lower risk of severe hypoglycemia, while frequent daily glucose testing was associated with lower HbA1c level. These findings imply that basic self-management skill and technology play complementary roles in glycemic control among older adults with long-standing T1DM.
Get full access to this article
View all access options for this article.
References
1.
The Diabetes Control and Complications Trial Research Group: The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med, 1993; 329:977–986.
2.
GreggEW, LiY, WangJ, et al.: Changes in diabetes-related complications in the United States, 1990–2010. N Engl J Med, 2014; 370:1514–1523.
3.
KleinR, KleinBE, MossSE, et al.: The Wisconsin Epidemiologic Study of Diabetic Retinopathy. III. Prevalence and risk of diabetic retinopathy when age at diagnosis is 30 or more years. Arch Ophthalmol, 1984; 102:527–532.
4.
Sustained effect of intensive treatment of type 1 diabetes mellitus on development and progression of diabetic nephropathy: the Epidemiology of Diabetes Interventions and Complications (EDIC) study. JAMA, 2003; 290:2159–2167.
5.
Institute of Health Economics: Insulin Pump Therapy for Type 1 Diabetes. Alberta STE Report. Edmonton, AB, Canada: Institute of Health Economics, 2012:26–28.
6.
Weissberg-BenchellJ, Antisdel-LomaglioJ, SeshadriR: Insulin pump therapy: a meta-analysis. Diabetes Care, 2003; 26:1079–1087.
7.
JakischBI, WagnerVM, HeidtmannB, et al.: Comparison of continuous subcutaneous insulin infusion (CSII) and multiple daily injections (MDI) in paediatric Type 1 diabetes: a multicentre matched-pair cohort analysis over 3 years. Diabet Med, 2008; 25:80–85.
8.
HoogmaRP, HammondPJ, GomisR, et al.: Comparison of the effects of continuous subcutaneous insulin infusion (CSII) and NPH-based multiple daily insulin injections (MDI) on glycaemic control and quality of life: results of the 5-Nations Trial. Diabet Med, 2006; 23:141–147.
9.
MissoML, EgbertsKJ, PageM, et al.: Continuous subcutaneous insulin infusion (CSII) versus multiple insulin injections for type 1 diabetes mellitus. Cochrane Database Syst Rev, 2010;(1):CD005103.
10.
DidangelosT, IliadisF: Insulin pump therapy in adults. Diabetes Res Clin Pract, 2011; 93(Suppl 1):S109–S113.
11.
PickupJC, SuttonAJ: Severe hypoglycaemia and glycaemic control in Type 1 diabetes: meta-analysis of multiple daily insulin injections compared with continuous subcutaneous insulin infusion. Diabet Med, 2008; 25:765–774.
12.
WalshJ, RobertsR: Pumping Insulin: Everything You Need to Succeed on an Insulin Pump, 5th ed. La Jolla, CA: Torrey Pines Press, 2012.
13.
SchuttM, FachEM, SeufertJ, et al.: Multiple complications and frequent severe hypoglycaemia in ‘elderly’ and ‘old’ patients with Type 1 diabetes. Diabet Med, 2012; 29:e176–e179.
14.
BolandEA, GreyM, OesterleA, et al.: Continuous subcutaneous insulin infusion. A new way to lower risk of severe hypoglycemia, improve metabolic control, and enhance coping in adolescents with type 1 diabetes. Diabetes Care, 1999; 22:1779–1784.
15.
BrinkSJ, StewartC: Insulin pump treatment in insulin-dependent diabetes mellitus. Children, adolescents, and young adults. JAMA, 1986; 255:617–621.
16.
WeismanA, LovblomLE, RovinskiR, et al.: Neuropathy prevalence compared with other complications in longstanding T1DM: preliminary analysis of the Canadian Study of Longevity in Diabetes cohort [abstract 1580-P]. Diabetes, 2015; 64(Suppl 1):A411.
17.
BaiJW, BouletG, HalpernEM, et al.: Cardiovascular disease guideline adherence and self-reported statin use in longstanding type 1 diabetes: results from the Canadian Study of Longevity in Diabetes cohort. Cardiovasc Diabetol, 2016; 15:14.
18.
KeenanHA, CostacouT, SunJK, et al.: Clinical factors associated with resistance to microvascular complications in diabetic patients of extreme disease duration: the 50-year medalist study. Diabetes Care, 2007; 30:1995–1997.
19.
BainSC, GillGV, DyerPH, et al.: Characteristics of Type 1 diabetes of over 50 years duration (the Golden Years Cohort). Diabet Med, 2003; 20:808–811.
20.
LeveyAS, StevensLA, SchmidCH, et al.: A new equation to estimate glomerular filtration rate. Ann Intern Med, 2009; 150:604–612.
21.
MontorioI, IzalM: The Geriatric Depression Scale: a review of its development and utility. Int Psychogeriatr, 1996; 8:103–112.
22.
WancataJ, AlexandrowiczR, MarquartB, et al.: The criterion validity of the Geriatric Depression Scale: a systematic review. Acta Psychiatr Scand, 2006; 114:398–410.
23.
WelchGW, JacobsonAM, PolonskyWH: The Problem Areas in Diabetes Scale. An evaluation of its clinical utility. Diabetes Care, 1997; 20:760–766.
24.
MoghtaderiA, BakhshipourA, RashidiH: Validation of Michigan neuropathy screening instrument for diabetic peripheral neuropathy. Clin Neurol Neurosurg, 2006; 108:477–481.
25.
FeldmanEL, StevensMJ, ThomasPK, et al.: A practical two-step quantitative clinical and electrophysiological assessment for the diagnosis and staging of diabetic neuropathy. Diabetes Care, 1994; 17:1281–1289.
26.
ChengAY: Canadian Diabetes Association 2013 clinical practice guidelines for the prevention and management of diabetes in Canada. Introduction. Can J Diabetes, 2013; 37(Suppl 1):S1–S3.
27.
SunJK, KeenanHA, CavalleranoJD, et al.: Protection from retinopathy and other complications in patients with type 1 diabetes of extreme duration: the Joslin 50-year Medalist Study. Diabetes Care, 2011; 34:968–974.
28.
Gonder-FrederickLA, SchmidtKM, VajdaKA, et al.: Psychometric properties of the Hypoglycemia Fear Survey-II for adults with type 1 diabetes. Diabetes Care, 2011; 34:801–806.
29.
HarrisSB, WorrallG, MacaulayAC, et al.: Diabetes management in Canada: baseline results of the Group Practice Diabetes Management Study. Can J Diabetes, 2006; 30:131–137.
30.
KrolewskiAS, WarramJH: Natural history of diabetes mellitus. In: Becker KL, ed. Principles and Practice of Endocrinology and Metabolism. Philadelphia: J.B. Lippincott Co., 1995:1216–1220.
31.
PambiancoG, CostacouT, EllisD, et al.: The 30-year natural history of type 1 diabetes complications: the Pittsburgh Epidemiology of Diabetes Complications Study experience. Diabetes, 2006; 55:1463–1469.
32.
WhiteHD, GoenkaN, FurlongNJ, et al.: The U.K. service level audit of insulin pump therapy in adults. Diabet Med, 2014; 31:412–418.
33.
HSBC Global Research: Diabetes: Proprietary Survey on Insulin Pumps and Continuous Blood Glucose Monitoring.. Healthcare US Equipment & Supplies, 2005. www.research.hsbc.com/midas/Res/RDV?p=pdf&key=y8f6w0euwd&name=121747.PDf (accessed February1, 2015).
34.
PickupJC, HammondP: NICE guidance on continuous subcutaneous insulin infusion 2008: review of the technology appraisal guidance. Diabet Med, 2009; 26:1–4.
35.
Canadian Diabetes Association: Access to Medications, Devices and Supplies & Your Rights. 2014. www.diabetes.ca/diabetes-and-you/know-your-rights/access-to-medications-devices-supplies-your-rights (accessed February1, 2015).
36.
RothmanKJ, GreenlandS, LashTL: Modern Epidemiology. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins, 2012.
37.
MillerKM, FosterNC, BeckRW, et al.: Current state of type 1 diabetes treatment in the U.S.: updated data from the T1D Exchange clinic registry. Diabetes Care, 2015; 38:971–978.
38.
MatejkoB, CyganekK, KatraB, et al.: Insulin pump therapy is equally effective and safe in elderly and young type 1 diabetes patients. Rev Diabet Stud, 2011; 8:254–258.
39.
RizviAA, PetryR, ArnoldMB, et al.: Beneficial effects of continuous subcutaneous insulin infusion in older patients with long-standing type 1 diabetes. Endocr Pract, 2001; 7:364–369.
40.
Siegel-CzarkowskiL, HeroldKC, GolandRS: Continuous subcutaneous insulin infusion in older patients with type 1 diabetes. Diabetes Care, 2004; 27:3022–3023.
41.
ShalitinS, GilM, NimriR, et al.: Predictors of glycaemic control in patients with Type 1 diabetes commencing continuous subcutaneous insulin infusion therapy. Diabet Med, 2010; 27:339–347.
42.
The DCCT Research Group: Epidemiology of severe hypoglycemia in the Diabetes Control and Complications Trial. Am J Med, 1991; 90:450–459.
43.
LinkeschovaR, RaoulM, BottU, et al.: Less severe hypoglycaemia, better metabolic control, and improved quality of life in Type 1 diabetes mellitus with continuous subcutaneous insulin infusion (CSII) therapy; an observational study of 100 consecutive patients followed for a mean of 2 years. Diabet Med, 2002; 19:746–751.
44.
NewJP, AjjanR, PfeifferAF, et al.: Continuous glucose monitoring in people with diabetes: the randomized controlled Glucose Level Awareness in Diabetes Study (GLADIS). Diabet Med, 2015; 32:609–617.
45.
ThomasLE, KaneMP, BakstG, et al.: A glucose meter accuracy and precision comparison: the FreeStyle Flash Versus the Accu-Chek Advantage, Accu-Chek Compact Plus, Ascensia Contour, and the BD Logic. Diabetes Technol Ther, 2008; 10:102–110.
