Endocrine Abstracts

Background: Continuous subcutaneous insulin infusion (CSII) using an external pump is an alternative intensive diabetes therapy recognized to improve metabolic control and glycemic instability in selected type 1 diabetic (T1DM) subjects. The aim of this study was to examine the clinical effectiveness and safety of CSII systems over a 5-year follow-up period in T1DM patients.

Materials and methods: We performed a retrospective observational study of T1DM patients previously treated with multiple daily insulin therapy who initiated CSII until December 2010. We analyzed A1C, weight and total daily insulin dose (TDD) at the start of therapy, 6 months after and then annually for 5 years. We examined the occurrence of hypoglycemic and diabetic ketoacidosis (DKA) episodes and local problems at infusion site.

Results: We followed 92 patients treated with CSII during 4.08±3.01years, 62% female, mean age 28.73±11.7years-old, diabetes duration 15.63±8.97 years. The main reasons for starting CSII were: poor glycemic control in 47.7%, glycemic instability 31.1%, frequent and unnoticed hypoglycemia 12.1% and dawn phenomenon in 4.5%. Baseline A1C was 8.79±1.62% and decreased to a minimum of 7.58±1.0% at 6 months (P<0.05). Compared to baseline, A1C remained lower in all follow-up period (P<0.05). Patients followed during 5 years maintained lower A1C (8.95±1.6% vs 7.60±0.94%, P<0.05), although we verified a slight increase between 1 and 4 years (7.35±1.08% vs 7.75±0.91%, P<0.05). Insulin requirements reduced from 57.7UI/day to 41.3UI/day (P<0.05) at 6 months and we found no statistically weight difference (59.5 vs 58.3 kg). We registed 18 severe hypoglycemia (incidence 0.057/patient/year), 12 DKA (0.038/patient/year) and 11 recurrent infections at the infusion site. Eight (8.7%) patients quit pump therapy mainly because of maladaptation.

Conclusion: In this study CSII improved glycemic control during long term follow-up and reduced total daily insulin requirements. The rate of major complications was low and similar to those reported in other studies.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.