The DOI matches its Crossref record; 40 of the 40 references it cites were found in a registry or an index.
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
Open accessAbstract
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.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Insulin pumps, particularly automated insulin delivery (AID) pumps which communicate with or incorporate continuous glucose monitoring systems (CGMs), are associated with numerous benefits, including a lower incidence of hospitalization for diabetic ketoacidosis (DKA) compared to those that rely on multiple daily injections [3].”
From Performance of a Continuous Subcutaneous Insulin Infusion (CSII) Pump With Acoustic Volume and Flow Sensing in Simulated High-Consequence Situations (2024) · cites this paper as [3]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“Occurrences of severe hypoglycemia and DKA (9.0 and 0.6 events per 100 person-years, respectively, in the safety cohort) observed during the study period are in line with other literature with estimates ranging from 7 to 130 and 4 to 8 events per 100 person-years, respectively, in insulin-requiring diabetes populations using MDI therapy (39-43).”
From Observed Glycemic and Psychosocial Benefits in the Prospective Bigfoot Unity Real World Study: A 6-Month Analysis (2025) · cites this paper as [40]
The cited source says what the claim attributes to it.
In the citing paper
“Continuous subcutaneous insulin infusion is associated with improved clinical outcomes in both type 1 diabetes (T1D)2 -4 and insulin-dependent type 2 diabetes (T2D).5,6”
From Bench-Side Dose Accuracy of an Open-Source Ultra-Low-Cost Insulin-Pump, With Testing Conducted to IEC 60601-2-24 (2024) · cites this paper as [3]
In the citing paper
“There is also evidence that insulin pump therapy may reduce DKA risk (182,186) and diabetes complications, particularly retinopathy and peripheral neuropathy in youth, compared with MDI (169).”
From 7. Diabetes Technology: Standards of Care in Diabetes—2025 (2025) · cites this paper as [182]
In the citing paper
“With this combination, it is possible to shift HbA1c values and “time in range” (TIR) into the normal range without increasing the risk of hypoglycemia [ 62 ].”
From Hypoglycemia Unawareness—A Review on Pathophysiology and Clinical Implications (2024) · cites this paper as [62]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
Controlling the False Discovery Rate: A Practical and Powerful Approach to Multiple Testing
Benjamini, Y., & Hochberg, Y. (1995) · Journal of the Royal Statistical Society Series B: Statistical Methodology · doi:10.1111/j.2517-6161.1995.tb02031.x · Cited by 109,482
Austin, P. C. (2011) · Multivariate Behavioral Research · doi:10.1080/00273171.2011.568786 · Cited by 12,242
Austin, P. C., & Stuart, E. A. (2015) · Statistics in Medicine · doi:10.1002/sim.6607 · Cited by 4,495
(2009) · Cited by 1,811
Defining and Reporting Hypoglycemia in Diabetes
American Diabetes Association Workgroup on Hypoglycemia (2005) · Diabetes Care · doi:10.2337/diacare.28.5.1245 · Cited by 1,146
Effectiveness of Sensor-Augmented Insulin-Pump Therapy in Type 1 Diabetes
Bergenstal, R. M., Tamborlane, W. V., Ahmann, A., Buse, J. B., Dailey, G., Davis, S. N., Joyce, C., Peoples, T., Perkins, B. A., Welsh, J. B., et al. (2010) · New England Journal of Medicine · doi:10.1056/nejmoa1002853 · Cited by 894
Pickup, J. C., & Sutton, A. J. (2008) · Diabetic Medicine · doi:10.1111/j.1464-5491.2008.02486.x · Cited by 630
Home Use of an Artificial Beta Cell in Type 1 Diabetes
Thabit, H., Tauschmann, M., Allen, J. M., Leelarathna, L., Hartnell, S., Wilinska, M. E., Acerini, C. L., Dellweg, S., Benesch, C., Heinemann, L., et al. (2015) · New England Journal of Medicine · doi:10.1056/nejmoa1509351 · Cited by 450
Nocturnal Glucose Control with an Artificial Pancreas at a Diabetes Camp
Phillip, M., Battelino, T., Atlas, E., Kordonouri, O., Bratina, N., Miller, S., Biester, T., Stefanija, M. A., Muller, I., Nimri, R., et al. (2013) · New England Journal of Medicine · doi:10.1056/nejmoa1206881 · Cited by 431
Self-citationLy, T. T., Nicholas, J. A., Retterath, A., Lim, E. M., Davis, E. A., & Jones, T. W. (2013) · JAMA · doi:10.1001/jama.2013.277818 · Cited by 411
Cited by
Sorted by citations
State of Type 1 Diabetes Management and Outcomes from the T1D Exchange in 2016–2018
Foster, N. C., Beck, R. W., Miller, K. M., Clements, M. A., Rickels, M. R., DiMeglio, L. A., Maahs, D. M., Tamborlane, W. V., Bergenstal, R., Smith, E., et al. (2019) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2018.0384 · Cited by 1,907
Wolfsdorf, J. I., Glaser, N. S., Agus, M. S. D., Fritsch, M., Hanås, R., Rewers, A., Sperling, M. A., & Ethel Codner, D. (2018) · Pediatric Diabetes · doi:10.1111/pedi.12701 · Cited by 724
“26 per 100 patient-years) in patients using pump therapy.(64) In recurrent DKA, insulin omission or failure to follow sick day or pump failure management guidelines accounts for almost all episodes.”
Dhatariya, K. K., Glaser, N. S., Codner, E., & Umpierrez, G. E. (2020) · Nature Reviews Disease Primers · doi:10.1038/s41572-020-0165-1 · Cited by 461
7. Diabetes Technology: Standards of Medical Care in Diabetes—2022
American Diabetes Association Professional Practice Committee (2022) · Diabetes Care · doi:10.2337/dc22-s007 · Cited by 358
“There is also evidence that CSII may reduce DKA risk (155,160) and diabetes”
Background7. Diabetes Technology: Standards of Care in Diabetes—2025
American Diabetes Association Professional Practice Committee, ElSayed, N. A., McCoy, R. G., Aleppo, G., Balapattabi, K., Beverly, E. A., Briggs Early, K., Bruemmer, D., Echouffo-Tcheugui, J. B., Ekhlaspour, L., et al. (2025) · Diabetes Care · doi:10.2337/dc25-s007 · Cited by 348
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
- 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
- bronze
- doi.org
- 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
