Durability of Insulin Pump Use in Pediatric Patients With Type 1 Diabetes
Open accessAbstract
OBJECTIVE—To examine longitudinal outcomes, rate of and reasons for discontinuation, and predictors of insulin pump success in a cohort of youth initiating pump therapy. RESEARCH DESIGN AND METHODS—We followed a cohort of youth with type 1 diabetes (n = 161) starting the pump between 1998 and 2001 and recorded natural history of treatment. RESULTS—At pump start, patients (71% female) had a mean age of 14.1 ± 3.7 years, diabetes duration of 7.1 ± 4.0 years, daily blood glucose monitoring (BGM) frequency of 4.0 ± 1.2, a daily insulin dose of 1.0 ± 0.3 units/kg, and an HbA1c (A1C) of 8.4 ± 1.4%. After 1 year, mean daily BGM frequency was 4.5 ± 1.7, daily insulin dose was 0.8 ± 0.2 units/kg, and A1C was 8.1 ± 1.3% (all baseline versus 1-year data, P < 0.01). As of 2005, 29 patients (18%) had resumed injection therapy at a mean age of 17.0 ± 2.9 years after a mean duration of pump use of 2.1 ± 1.3 years. BGM frequency at baseline and at 1 year was significantly lower in the patients who resumed injection therapy (P < 0.02). In addition, patients who remained on the pump had lower A1C than those who resumed injection therapy at both 1 year (P = 0.04) and at the most recent clinic visit (P = 0.01). CONCLUSIONS—After an average of 3.8 years, >80% of pediatric patients maintained pump therapy with preservation of baseline A1C. Patients discontinuing the pump were less adherent and did not achieve equivalent glycemic benefit compared with continued users; these patients require ongoing support aimed at improving adherence and outcomes.
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Insulin pump discontinuation is commonly due to IIS failure.
“This aligns with previous findings that insulin pump discontinuation is commonly due to IIS failure.19”
From Frequency and Detection of Insulin Infusion Site Failure in the Type 1 Diabetes Exchange Online Community (2023) · cites this paper as [19]
The Results and Conclusions (page unavailable) identify infusion-site issues as one of the common reasons for discontinuation in this pediatric cohort; minor problems such as infusion-site issues accounted for 21% of discontinuations. The paper does not identify insulin infusion set (IIS) failure specifically as the cause, so the claim is more specific than the evidence. (LLM, conf=0.86)
Experimental — accuracy not yet measuredProblems with infusion sets are a reason for patients discontinuing insulin pump therapy.
“and a reason for patients discontinuing insulin pump therapy. 21,37-39”
From Real-Time Detection of Infusion Site Failures in a Closed-Loop Artificial Pancreas (2018) · cites this paper as [37]
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- Authors
- Wood, J. R., Moreland, E. C., Volkening, L. K., Svoren, B. M., Butler, D. A., & Laffel, L. M. B.
- Affiliations
- Joslin Diabetes Center (US)
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2006-11-01
- Volume
- 29
- Issue
- 11
- Pages
- 2355-2360
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W2078077635
- Cited by
- 98
- References
- 20
- Citations by year
- 2023: 4 · 2022: 4 · 2021: 4 · 2020: 3 · 2019: 4 · 2018: 8 · 2017: 1 · 2016: 10 · 2015: 4 · 2014: 11 · 2013: 3 · 2012: 11
- FWCI
- 3.64
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American Diabetes Association
- University of Alabama at Birmingham
- National Institutes of Health
- National Institute of Diabetes and Digestive and Kidney Diseases (T32DK063702, K12DK063696, R01 DK46887, R01DK046887)
- 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, type 1 diabetes, pediatric patients, treatment discontinuation, glycemic control, HbA1c, blood glucose monitoring, insulin dose, predictors of treatment success
- MeSH terms
- Adolescent, Child, Diabetes Mellitus, Type 1, Female, Follow-Up Studies, Glycated Hemoglobin, Humans, Hypoglycemia, Hypoglycemic Agents, Insulin, Insulin Infusion Systems, Male, Patient Compliance, Cohort Studies, Treatment Outcome, Patient Satisfaction
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