Real-world data support reduced hypoglycemia risk in young pump users
medwireNews: Findings from a population-based study indicate that insulin pump use is associated with reduced risks for severe hypoglycemia and diabetic ketoacidosis in children, adolescents, and young adults with type 1 diabetes.
“Whereas previous randomized clinical trials have been too small to assess the risk of these short-term diabetes complications, this study provides outcome data in clinical use that are likely representative of patients with type 1 diabetes across the pediatric age spectrum,” say Reinhard Holl (University of Ulm, Germany) and co-researchers.
Furthermore, pump users also achieved better overall glycemic control than patients who were injecting insulin, the study published in JAMA shows.
The researchers studied data from 30,579 type 1 diabetes patients younger than 20 years of age who were participating in the Diabetes Prospective Follow-up Initiative in Germany, Austria, and Luxembourg. From these, they identified 9814 pump users who could be matched to an equal number of multiple daily injection users on variables that influenced the propensity to receive a pump (age, sex, duration of diabetes, migration background, BMI, and glycated hemoglobin [HbA1c]).
During the most recent treatment year, 6.4% of all matched patients had severe hypoglycemia, including 2.1% with hypoglycemic coma. The event rates per 100 patient–years were 9.55 versus 13.97 for pump and injection users, respectively, giving a significantly reduced incidence rate ratio of 0.68 favoring pump use.
The equivalent rates for hypoglycemic coma were 2.30 versus 2.96 per 100 patient–years, giving an incidence rate ratio of 0.78, also significantly favoring pump use.
Diabetic ketoacidosis occurred in 3.7% of patients, and again rates were significantly lower in pump users than injection users, at 3.64 versus 4.26 per 100 patient–years and an incidence rate ratio of 0.85. The same was true for severe ketoacidosis, and all differences persisted when assessed in the full cohort with propensity score adjustment.
The researchers speculate that this reduction could be partly a result of patient education. “Prevention of ketoacidosis is an integral part of diabetes education and may be trained more intensively in patients receiving pump therapy, thereby reducing the incidence of ketoacidosis,” they suggest.
Patients using pumps had significantly lower HbA1c than injection users, at 8.04% versus 8.22%. This difference was seen in all age groups except patients aged between 1.5 and 5 years. Pump users self-monitored their blood glucose more frequently than injection users, and used less total insulin over the course of a day, but had a higher ratio of bolus to total insulin.
“Results of this study provide further evidence that insulin pump therapy, which is a core element of artificial beta cell technology, is safe and effective, even in routine diabetes care for unselected patients at a population-based level,” the team concludes.
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