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Open Access 09-05-2023 | Insulins | Original Article

Associations between clinical and psychosocial factors and HbA1c in adult insulin pump users with type 1 diabetes

Authors: Signe Schmidt, Kristoffer Panduro Madsen, Ulrik Pedersen-Bjergaard, Karen Rytter, Eva Hommel, Bryan Cleal, Ingrid Willaing, Henrik Ullits Andersen, Kirsten Nørgaard

Published in: Acta Diabetologica | Issue 8/2023

Abstract

Aims

Many adults with type 1 diabetes do not achieve recommended glycemic goals despite intensive insulin therapy using insulin pumps. The aim of this study was to explore associations between clinical and psychosocial factors and HbA1c in insulin pump users to identify and prioritize areas for potential intervention.

Methods

A questionnaire-based survey covering clinical and psychosocial aspects of life with type 1 diabetes was distributed to all adult (≥ 18 years) insulin pump users in the Capital Region of Denmark. Responses were combined with data from medical records and national registries. Associations with HbA1c were modeled using regression-based machine learning.

Results

Of 1,591 invited individuals, 770 (48.4%) responded to the survey. Mean HbA1c among responders was 7.3% (56 mmol/mmol), and 35.6% had an HbA1c < 7.0% (53 mmol/mol). Six factors were significantly associated with HbA1c: diabetes duration (0.006% (0.1 mmol/mol) lower HbA1c per 1-year increase in diabetes duration); education (0.4% (4.3 mmol/mol) lower HbA1c with long higher education vs. primary school); insulin type (0.2% (2.2 mmol/mol) lower HbA1c with ultra-rapid-acting insulin vs. rapid-acting insulin); hypoglycemia awareness status (0.2% (2.2 mmol/mol) lower HbA1c with complete unawareness vs. full awareness); insulin device satisfaction (0.2% (2.7 mmol/mol) lower HbA1c per 1-point increase in Insulin Device Satisfaction Survey score); and diabetes distress (0.3% (3.1 mmol/mol) higher HbA1c per 1-point increase in Type 1 Diabetes Distress Scale score).

Conclusions

This study identified several associations between clinical and psychosocial factors and HbA1c that may be considered when developing interventions targeted people with type 1 diabetes.

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Title: Associations between clinical and psychosocial factors and HbA1c in adult insulin pump users with type 1 diabetes
Authors: Signe Schmidt
Kristoffer Panduro Madsen
Ulrik Pedersen-Bjergaard
Karen Rytter
Eva Hommel
Bryan Cleal
Ingrid Willaing
Henrik Ullits Andersen
Kirsten Nørgaard
Publication date: 09-05-2023
Publisher: Springer Milan
Keywords: Insulins
Hypoglycemia
Insulins
Type 1 Diabetes
Published in: Acta Diabetologica / Issue 8/2023
Print ISSN: 0940-5429
Electronic ISSN: 1432-5233
DOI: https://doi.org/10.1007/s00592-023-02081-4

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