Endocrine Abstracts

Objective: To evaluate the response to treatment with insulin infusion pumps by the evolution of HbA1c over 8 years of experience.

Methods: Observational retrospective study. We evaluated the response to treatment in 122 patients with type 1 diabetes recruited between 2004 and 2012 in our area.

Results: Between 2004 and 2012, 122 pumps have been implemented (average of 17.4 pumps/year). The number decreased to only four in 2012. Prescription indications were: glycemic instability (14.7%), poor metabolic control (44%), hypoglycemia (18%), pregnancy (9%) and pregnancy planning (12.3%). There have been 13 dropouts (10.6%): no adaptation to therapy (38.4%), poor compliance and poor control (30.7%), no improvement (23%) and termination of pregnancy (7.7%). During the 1st year we observed a decrease in mean HbA1c of 0.7%, maintained in the second year and beyond, ranging between 0.6 and 0.5% in the 5th year of follow-up (P<0,05). In patients with poor metabolic control, HbA1c improvement is proportionally higher, ranging from 9.6 to 7.7% prior to year 6 (P < 0.05). There is a decrease in HbA1c at baseline (0.4%) due to the education program received (P < 0.05). The percentage of patients with better HbA1c than at baseline decreases as the years pass, from 97% the 1st month to 75% after the first year and 50% at 6 years of treatment.

Conclusions: This therapy has been effective in most patients. For better results an appropriated selection of candidates is required.The decrease in HbA1c is more pronounced in the first months of treatment and has already started before the implantation of the insulin pump, probably by the intensive educational program received.