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Factors associated with withdrawal from insulin pump therapy: A large‐population‐based study
Author(s) -
Merzon Eugene,
Grossman Jeremy,
Vinker Shlomo,
Merhasin Ilia,
Levit Shmuel,
GolanCohen Avivit
Publication year - 2020
Publication title -
diabetes/metabolism research and reviews
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.307
H-Index - 110
eISSN - 1520-7560
pISSN - 1520-7552
DOI - 10.1002/dmrr.3288
Subject(s) - medicine , type 1 diabetes , odds ratio , depression (economics) , population , insulin , diabetes mellitus , type 2 diabetes , endocrinology , environmental health , economics , macroeconomics
Background Although, number of diabetic patients received insulin pump (IP) therapy is increasing; there are limited data regarding factors associated with IP withdrawal. Methods We conducted a cross‐sectional study using data from an Israeli health maintenance organization. All patients, 21 or older, with type 1 (T1DM) or type 2 (T2DM) diabetes, who received IP therapy for a 7‐year period were identified. Patients who did not purchase IP maintenance supplies for at least six consecutive months were defined as withdrawn (N = 355). Patients who purchased supplies were defined as adherent (N = 352). Results In both T1DM and T2DM patients, withdrawal from IP therapy was positively associated with duration of diabetes longer than 5 years (odds ratio [OR] = 13.26 [CI, 7.16‐23.34; P < .001] and OR = 10.92 [CI, 5.64‐21.14; P < .001], respectively), nonadherence to dietician follow‐up (OR = 5.78 [CI, 3.65‐9.14; P < .001] and OR = 3.41 [CI, 1.99‐5.85; P < .001], respectively), and poor glycaemic control prior to IP treatment (OR = 4.04 [CI, 2.18‐7.48; P < .001] and OR = 4.59 [CI, 2.71‐7.81; P < .001], respectively]. Co‐morbid neuro‐psychiatric disorders were also risk factors for IP withdrawal: diagnosis of depression (OR = 2.22 [CI, 1.16‐4.27; P = .017] and Attention Deficit Hyperactivity Disorder (ADHD) OR = 2.45 [CI, 1.003‐5.087; P = .043]) among T1DM patients; and diagnosis of depression (OR = 1.85 [CI, 1.05‐5.27; P = .046] and dementia OR = 4.03 [CI, 1.03‐19.77; P = .048]) among T2DM patients. Conclusion In our large real‐world population‐based study, we found that smoking, obesity, poor glycaemic control, and co‐morbid neuro‐psychiatric disorders were associated with a high rate of withdrawal from IP therapy. Health care providers ought to familiarize themselves with patient characteristics predictive of nonadherence and should intensify patient follow‐up when incorporating this new, costly, and challenging technology.