Prevalence and geographical distribution of insulin pump therapy in the Central Denmark Region and its association with metabolic parameters
Abstract
Aims Insulin treatment in type 1 diabetes encompasses multiple daily insulin injections (MDI) or continuous subcutaneous insulin infusion (CSII). Both population-based studies and comparative studies regarding CSII use are sparse. The aim of the current study was to describe the prevalence and distribution of CSII use among adults with type 1 diabetes in the Central Denmark Region and to compare metabolic control in CSII-treated patients to those treated with MDI. Methods A database was constructed using the Danish Adult Diabetes Registry in 2014/2015 in combination with an audit of the patients' medical records. Results 3909 adults with type 1 diabetes patients were included. The proportion of patients treated with CSII differed significantly between the 8 regional hospitals from 12.0% to 31.1%. CSII users had a significantly lower HbA1c compared to MDI treated patients (7.6% (60 mmol/mol) versus 8.0% (64 mmol/mol)) in unadjusted analyses. After adjustment for clinically relevant characteristics the difference between CSII and MDI-treated patients was attenuated, but remained statistically significant. Conclusion The distribution of CSII differed markedly between hospitals and CSII users had better glycemic control, even after adjustment for sex, age, BMI, diabetes duration, smoking, use of lipid-lowering and blood pressure-lowering medication.
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These differences in insulin pump use have been observed in both countries with insulin pump funding programs (New Zealand, Denmark, France) and those without (USA, Brazil).
“These differences have been observed in both countries with insulin pump funding programs (New Zealand, Denmark, France)9–11 and those without (USA, Brazil).12 13”
From Impact of government-funded insulin pump programs on insulin pump use in Canada: a cross-sectional study using the National Diabetes Repository (2021) · cites this paper as [11]
Among adults with type 1 diabetes, individuals who are older, male, ethnic minorities, or of lower income are significantly less likely to use insulin pumps.
“Indeed, among adults with type 1 diabetes, individuals who are older, male, ethnic minorities, or of lower income are significantly less likely to use insulin pumps.9–13”
From Impact of government-funded insulin pump programs on insulin pump use in Canada: a cross-sectional study using the National Diabetes Repository (2021) · cites this paper as [11]
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Gajewska, K., Bennett, K., Biesma, R., & Sreenan, S. (2020) · BMC Endocrine Disorders · doi:10.1186/s12902-020-00573-w · Cited by 21 · see citing works
“in England and Scotland has doubled since 2012 [15, 29], but this is still below that in the Nordic countries, Germany or the US [10, 26, 30, 31].”
BackgroundMadsen, K. P., Olsen, K. R., Rytter, K., Willaing, I., Pedersen-Bjergaard, U., Schmidt, S., Nørgaard, K., & Kjær, T. (2022) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2022.110225 · Cited by 15 · see citing works
Song, C., Booth, G. L., Perkins, B. A., & Weisman, A. (2021) · BMJ Open Diabetes Research & Care · doi:10.1136/bmjdrc-2021-002371 · Cited by 12 · see citing works
Rytter, K., Madsen, K. P., Andersen, H. U., Cleal, B., Hommel, E., Nexø, M. A., Pedersen-Bjergaard, U., Skinner, T., Willaing, I., Nørgaard, K., et al. (2021) · Diabetes Therapy · doi:10.1007/s13300-021-01181-0 · Cited by 10 · see citing works
“A study of all insulin pump users in the Central Region of Denmark in 2014–2015 found HbA1c, lipids and share of albuminuria cases similar to those found in the present survey [5].”
ResultMoreno-Fernández, J., Chico, A., Martínez-Brocca, M. A., Beato-Víbora, P., Vidal, M., Piedra, M., Quirós, C., & Muñoz-Rodríguez, J. (2022) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2022.0207 · Cited by 7 · see citing works
“19,20 Here, we describe a slightly lower HbA1c value (56.3 mmol/mol, 7.3”
InfluentialSchmidt, S., Madsen, K. P., Pedersen-Bjergaard, U., Rytter, K., Hommel, E., Cleal, B., Willaing, I., Andersen, H. U., & Nørgaard, K. (2023) · Acta Diabetologica · doi:10.1007/s00592-023-02081-4 · Cited by 5 · see citing works
The Evolution of Insulin Administration in Type 1 Diabetes
Pinnaro, C. T., & Tansey, M. J. (2021) · Journal of Diabetes Mellitus · doi:10.4236/jdm.2021.115021 · Cited by 5 · see citing works
Gajewska, K., Biesma, R., Bennett, K., & Sreenan, S. (2020) · Acta Diabetologica · doi:10.1007/s00592-020-01497-6 · Cited by 5 · see citing works
Thykjær, A., Rosengaard, L., Andersen, N., Andresen, J., Hajari, J., Heegaard, S., Højlund, K., Kawasaki, R., Laugesen, C., Möller, S., et al. (2024) · Journal of diabetes and its complications · doi:10.1016/j.jdiacomp.2024.108830 · Cited by 4 · see citing works
Moreno-Ferández, J., García-Seco, J. A., Herrera-Moraleda, M., Seco, A. M., & Muñoz-Rodríguez, J. (2020) · International Journal of Diabetes in Developing Countries · doi:10.1007/s13410-020-00887-4 · Cited by 4 · see citing works
“So far, few real-world studies with CSII compared with MDI have been conducted [2, 11, 12], particularly in the Mediterranean area [13].”
BackgroundInfluentialMarkakis, K., Alam, T., Jinadev, P., Chapman, A., Urwin, A., Thabit, H., Boulton, A., Rutter, M., & Leelarathna, L. (2019) · Journal of Diabetes Science and Technology · doi:10.1177/1932296818822818 · Cited by 3 · see citing works
“In a recent large observational study from the Danish Adult Diabetes Registry, CSII users found to have lower SBP compared to MDI users but the difference was no longer statistical significant after adjustment for sex, age, duration of diabetes, smoking, body mass index, and use of lipid-lowering and blood-pressure-lo…”
BackgroundAndreassen, J., Nikontovic, A., Iversen, E., Borðoy, R. Á. F., Rasmussen, P., Petersen, M. S., & Johannesen, H. (2025) · AACE endocrinology and diabetes · doi:10.1016/j.aed.2025.05.005
Improving Gestational Diabetes Detection in Pregnancy through Machine Learning Models
Ishaq, G., Umar, H. G. A., Saleem, L., Fareed, M., & Aqdas, M. (2024) · Sir Syed University Research Journal of Engineering & Technology · doi:10.33317/ssurj.652
- Authors
- Kampmann, U., Madsen, L. R., Bjerg, L., Witte, D. R., Hasselstrøm, K., Østergård, T., Alstrup, K., Møller, M. K., Dylmer, D., & Hansen, K. W.
- Affiliations
- Aarhus University Hospital (DK)
- Aarhus University (DK)
- Regionshospitalet Viborg (DK)
- Regional Hospital Randers (DK)
- Regional Hospital Horsens (DK)
- Regional Hospital Holstebro (DK)
- Regionshospitalet Silkeborg (DK)
- Corresponding author
- Kampmann, Ulla
- ORCID
- Venue
- Diabetes Research and Clinical Practice
- Publisher
- Elsevier BV
- Published
- 2018-07
- Volume
- 141
- Pages
- 148-155
- ISSN
- 0168-8227 (ISSN-L)
- OpenAlex
- W2802690760
- Cited by
- 19
- References
- 0
- Citations by year
- 2025: 2 · 2024: 2 · 2023: 2 · 2022: 3 · 2021: 3 · 2020: 6 · 2019: 1
- FWCI
- 1.99
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes Research and Clinical Practice (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Novo Nordisk Fonden
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- insulin pump therapy, type 1 diabetes, multiple daily insulin injections, glycemic control, HbA1c, prevalence, hospital variation, Central Denmark Region
- MeSH terms
- Adult, Denmark, Diabetes Mellitus, Type 1, Female, Humans, Hypoglycemic Agents, Injections, Subcutaneous, Insulin, Insulin Infusion Systems, Male, Middle Aged, Prevalence
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