Improved Glycemic Control Following Transition to Tubeless Insulin Pump Therapy in Adults with Type 1 Diabetes
Previous clinical evidence shows the beneficial effect of continuous subcutaneous insulin infusion (CSII) as compared to multiple daily injection (MDI) insulin regimens in patients with type 1 diabetes. With an increasing number of people opting for tubeless insulin pump therapy, there is a growing need to understand the long-term clinical outcomes of this therapy in various populations. Sanjeev N. Mehta and colleagues conducted a study titled “Improved Glycemic Control Following Transition to Tubeless Insulin Pump Therapy in Adults with Type 1 Diabetes” published in the Clinical Diabetes Journal. The summary of the study is given below:
Objective:
To evaluate the effect of tubeless insulin pump on glycemic control in adults with type 1 diabetes.
Method:
156 adults with type 1 diabetes participated in this multicenter, retrospective study. Tubeless insulin pump therapy was initiated following the transition from either MDI or CSII with a tubed insulin pump after glycemic control evaluation. The treatment effect was evaluated for 12 months.
Findings:
Transition to tubeless insulin pump has resulted in significant improvement in A1C in adults with type 1 diabetes after 12 months. Additionally, this transition has shown a greater reduction in A1C in patients with A1C >9%, while a relatively stable level of glycemic control was maintained in patients with A1C <9% at baseline. As compared to MDI therapy, CSII therapy is associated with improved glycemic control. Conversely, individuals who were receiving CSII therapy with tube pump at baseline were not necessarily expected to have a significant improvement in A1C, as they were already receiving the benefits of CSII therapy. However, these patients might experience benefits in other areas, such as quality of life. Weight was stable for patients in both groups.
Limitation:
Limitations include the retrospective nature of the analysis, exclusion of patients who did not have 12-month A1C data, lack of a control group, and lack of data regarding patient satisfaction and quality of life. Investigators weren’t able to assess glycemic control with consideration to continue glucose monitoring (CGM) use due to the unavailability of data for most participants on the modality of glucose measurement. The authors acknowledge that the smaller group of prior CSII users as compare to prior MDI users might have affected the ability to assess significant changes in this population. Lastly, due to insufficient prior CSII users with a high baseline, investigators were unable to assess the influence of prior therapy among those with a baseline A1C >9%.
Authors acknowledge future studies to investigate additional outcomes such as frequency of acute complications, total daily insulin use, quality of life measures, and patient preference for the tubeless insulin pump as compared to prior therapy.
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