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Real‐world outcomes of insulin pump compared to injection therapy in a population‐based sample of children with type 1 diabetes
Author(s) -
Burckhardt MarieAnne,
Smith Grant J.,
Cooper Matthew N.,
Jones Timothy W.,
Davis Elizabeth A.
Publication year - 2018
Publication title -
pediatric diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.678
H-Index - 75
eISSN - 1399-5448
pISSN - 1399-543X
DOI - 10.1111/pedi.12754
Subject(s) - medicine , insulin pump , glycemic , type 1 diabetes , cohort , population , insulin , diabetes mellitus , type 2 diabetes , cohort study , surgery , endocrinology , environmental health
Background Long‐term glycemic outcomes in people with type 1 diabetes (T1D) on insulin pump therapy (continuous subcutaneous insulin infusion [CSII]) with appropriate control data are limited. Randomized controlled studies of technology in diabetes care are generally limited in duration and likely to have a selection bias. Hence, evaluation of population‐based data provides a robust alternative evaluation of the benefits of insulin pump therapy. Aim To investigate the outcomes of insulin pump therapy, as compared to injection therapy, in children with T1D attending a state‐wide diabetes service in Western Australia. Methods Patients using insulin pump therapy between January 1999 and July 2016 were matched to patients on injection therapy on the basis of age, date of diagnosis, and hemoglobin A1C (HbA1c) at the start of pump therapy. Results A total of 513 pump‐injection matches were identified. The pump cohort had a significantly lower mean HbA1c for the first 6 years of follow‐up. The difference in HbA1c between the cohorts was observed by 6 months (3 mmol/mol [0.3%], standard error of the mean (SEM) 0.05, N = 463 matched pairs, P < 0.001) and was sustained with the greatest difference in HbA1c at 6 years (4 mmol/mol [0.4%], SEM 0.21, N = 112 matched pairs, P = 0.04). Beyond 6 years of follow‐up, the HbA1c was not significantly lower in the pump cohort ( N < 70 matched pairs). Conclusions Patients using insulin pump therapy had a better long‐term glycemic control relative to the matched injection therapy cohort. Large population‐based cohort studies using real‐world data provide a valuable perspective on evaluation of new technologies in children with T1D.