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Effect of 4 years subcutaneous insulin infusion treatment on albuminuria, kidney function and HbA 1c compared with multiple daily injections: a longitudinal follow‐up study
Author(s) -
Rosenlund S.,
Hansen T. W.,
Andersen S.,
Rossing P.
Publication year - 2015
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.12950
Subject(s) - medicine , albuminuria , renal function , diabetes mellitus , urology , endocrinology , confidence interval , creatinine , kidney disease , blood pressure
Abstract Aim The effect of insulin pump [continuous subcutaneous insulin infusion ( CSII )] treatment on diabetes complications in a modern clinical setting is largely unknown. We investigated the effect of 4 years CSII treatment on HbA 1c, albuminuria and kidney function compared with multiple daily injections ( MDI ) in a single‐centre clinical setting. Methods All patients initiating CSII treatment from 2004 to 2010 and followed for at least 4 years were included in the study: 193 people with Type 1 diabetes were matched (1 : 2) with 386 patients treated with MDI in the same period. Matching was based on diabetes duration, gender, HbA 1c and normo‐, micro‐ or macroalbuminuria at baseline. Urinary albumin/creatinine ratio ( UACR ) was measured yearly and annual change assessed from linear regression. Results CSII ‐ vs. MDI ‐treated patients were comparable at baseline. After 4 years, HbA 1c was 62 ± 11 vs. 68 ± 11 mmol/mol (7.8 ± 1.0 vs. 8.4 ± 1.0%) ( P < 0.001). Annual UACR change in CSII ‐ vs. MDI ‐treated patients was [mean (95% confidence interval)] −10.1 (−13.3; −6.8) vs. −1.2 (−3.6; 0.9)% ( P < 0.001). Reduction in UACR was significantly associated with CSII treatment after adjustment for age, gender, diabetes duration, estimated GFR , UACR , mean arterial pressure, HbA 1c , cholesterol, renin–angiotensin–aldosterone system inhibition, anti‐hypertensive treatment and smoking ( P < 0.001). This remained significant ( P < 0.001) when only including patients on stable renin–angiotensin–aldosterone system inhibition during follow‐up ( n = 465). Conclusions Treatment with CSII over 4 years independently reduced HbA 1c and UACR compared with MDI . Reduced UACR may be due to less glycaemic variability because the effect of CSII on HbA 1c could only partially explain the effect. This needs confirmation in randomized controlled trials.