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Association of Insulin Pump Therapy vs Insulin Injection Therapy With Severe Hypoglycemia, Ketoacidosis, and Glycemic Control Among Children, Adolescents, and Young Adults With Type 1 Diabetes

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Karges, Beate, Schwandt, Anke, Heidtmann, Bettina, Kordonouri, Olga, Binder, Elisabeth, Schierloh, Ulrike, Boettcher, Claudia, Kapellen, Thomas, Rosenbauer, Joachim, Holl, Reinhard W.·2017·JAMA
DOI 10.1001/jama.2017.13994PMC PMC5818842
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Abstract

Importance: Insulin pump therapy may improve metabolic control in young patients with type 1 diabetes, but the association with short-term diabetes complications is unclear. Objective: To determine whether rates of severe hypoglycemia and diabetic ketoacidosis are lower with insulin pump therapy compared with insulin injection therapy in children, adolescents, and young adults with type 1 diabetes. Design, Setting, and Participants: Population-based cohort study conducted between January 2011 and December 2015 in 446 diabetes centers participating in the Diabetes Prospective Follow-up Initiative in Germany, Austria, and Luxembourg. Patients with type 1 diabetes younger than 20 years and diabetes duration of more than 1 year were identified. Propensity score matching and inverse probability of treatment weighting analyses with age, sex, diabetes duration, migration background (defined as place of birth outside of Germany or Austria), body mass index, and glycated hemoglobin as covariates were used to account for relevant confounders. Exposures: Type 1 diabetes treated with insulin pump therapy or with multiple (≥4) daily insulin injections. Main Outcomes and Measures: Primary outcomes were rates of severe hypoglycemia and diabetic ketoacidosis during the most recent treatment year. Secondary outcomes included glycated hemoglobin levels, insulin dose, and body mass index. Results: Of 30 579 patients (mean age, 14.1 years [SD, 4.0]; 53% male), 14 119 used pump therapy (median duration, 3.7 years) and 16 460 used insulin injections (median duration, 3.6 years). Patients using pump therapy (n = 9814) were matched with 9814 patients using injection therapy. Pump therapy, compared with injection therapy, was associated with lower rates of severe hypoglycemia (9.55 vs 13.97 per 100 patient-years; difference, -4.42 [95% CI, -6.15 to -2.69]; P < .001) and diabetic ketoacidosis (3.64 vs 4.26 per 100 patient-years; difference, -0.63 [95% CI, -1.24 to -0.02]; P = .04). Glycated hemoglobin levels were lower with pump therapy than with injection therapy (8.04% vs 8.22%; difference, -0.18 [95% CI, -0.22 to -0.13], P < .001). Total daily insulin doses were lower for pump therapy compared with injection therapy (0.84 U/kg vs 0.98 U/kg; difference, -0.14 [-0.15 to -0.13], P < .001). There was no significant difference in body mass index between both treatment regimens. Similar results were obtained after propensity score inverse probability of treatment weighting analyses in the entire cohort. Conclusions and Relevance: Among young patients with type 1 diabetes, insulin pump therapy, compared with insulin injection therapy, was associated with lower risks of severe hypoglycemia and diabetic ketoacidosis and with better glycemic control during the most recent year of therapy. These findings provide evidence for improved clinical outcomes associated with insulin pump therapy compared with injection therapy in children, adolescents, and young adults with type 1 diabetes.

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Metadata

Authors
Karges, B., Schwandt, A., Heidtmann, B., Kordonouri, O., Binder, E., Schierloh, U., Boettcher, C., Kapellen, T., Rosenbauer, J., & Holl, R. W.
Affiliations
  • RWTH Aachen University (DE)
  • Universität Ulm (DE)
  • Katholisches Kinderkrankenhaus Wilhelmstift (DE)
  • Kinderkrankenhaus auf der Bult (DE)
  • Innsbruck Medical University (AT)
  • Centre Hospitalier de Luxembourg (LU)
  • Justus-Liebig-Universität Gießen (DE)
  • University Hospital Leipzig (DE)
  • Deutsches Diabetes-Zentrum e.V. (DE)
Corresponding author
Karges, Beate
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2017-10-10
Volume
318
Issue
14
Pages
1358
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.2017.13994
PMC
PMC5818842
OpenAlex
W2764247723
Cited by
452
References
40
Citations by year
2026: 32 · 2025: 31 · 2024: 48 · 2023: 56 · 2022: 59 · 2021: 74 · 2020: 57 · 2019: 59 · 2018: 28 · 2017: 5
FWCI
32.23
Type
journal article
Language
en
Open access
Locations
  • JAMA (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • RWTH Publications (RWTH Aachen) (submittedVersion)
Funders
European Foundation for the Study of Diabetes
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
Keywords
insulin pump therapy, insulin injection therapy, type 1 diabetes, severe hypoglycemia, diabetic ketoacidosis, HbA1c, glycemic control, children and adolescents, young adults, insulin dose, body mass index, diabetes complications, migration background, diabetes duration, health care utilization, health care costs
MeSH terms
Adolescent, Blood Glucose, Child, Child, Preschool, Diabetes Mellitus, Type 1, Female, Glycated Hemoglobin, Humans, Hypoglycemia, Hypoglycemic Agents, Infant, Injections, Insulin, Insulin Infusion Systems, Male, Regression Analysis, Cohort Studies, Diabetic Ketoacidosis, Young Adult

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