Top

Endocrine

Published in:

01-01-2022 | Statins | Original Article

Predictors of the effectiveness of insulin pumps in patients with type 1 diabetes mellitus

Authors: Joana Camões Neves, João Sérgio Neves, Celestino Neves, Davide Carvalho

Published in: Endocrine | Issue 1/2022

Abstract

Purpose

Insulin pump therapy has become the preferential treatment for type 1 diabetes (T1D) as it mimics the physiological secretion of insulin better than multiple daily injections. However, not all patients improve with insulin pump therapy. This study aims to determine the predictors of the effectiveness of insulin pumps in T1D.

Methods

We conducted a retrospective observational study of patients who started insulin pumps. Data from four timepoints (before, at 6, 12, and 36 months) were evaluated for outcomes of glycemic control and safety. The association of baseline predictors with outcomes was analyzed using linear and logistic regression models.

Results

We evaluated 136 patients (57.4% females, age 36 ± 12 years, duration of T1D 14 ± 9 years). During the follow-up, there was a mean decrease of HbA1c of 0.9 ± 1.2%. The improvement in HbA1c was independent of sex, age, and duration of T1D. Higher baseline HbA1c, family history of diabetes, and not being treated with statins were predictors of improvement in HbA1c. Not being treated with statins and higher baseline HbA1c predicted improvement in HbA1c without worsening hypoglycemia. History of hypoglycemia was a predictor of severe hypoglycemia. Family history, higher baseline HbA1c, and psychological/psychiatric disorders were predictors of ketoacidosis.

Conclusion

Benefits of insulin pump were independent of sex, age, and duration of T1D. Baseline HbA1c, family history of diabetes, treatment with statins, history of hypoglycemia, and psychological/psychiatric disorders were predictors of outcomes, and may allow the identification of patients who benefit most from insulin pump therapy or who are at increased risk of complications.

Available only for authorised users

D.A. Schatz, P.J. Bingley, Update on major trials for the prevention of type I diabetes mellitus: The American Diabetes Prevention Trial (DPT-1) and the European Nicotinamide Diabetes Intervention Trial (ENDIT). J. Pediatr. Endocrinol. Metab. 14(Supplement), 619–622 (2001). https://doi.org/10.1515/JPEM.2001.14.S1.619CrossRefPubMed

A. Katsarou, S. Gudbjörnsdottir, A. Rawshani, D. Dabelea, E. Bonifacio, B.J. Anderson, L.M. Jacobsen, D.A. Schatz, Å. Lernmark, Type 1 diabetes mellitus. Nat. Rev. Dis. Prim. 3(1), 1–17 (2017). https://doi.org/10.1038/nrdp.2017.16CrossRef

M.A. Atkinson, G.S. Eisenbarth, A.W. Michels, Type 1 diabetes. Lancet 383(9911), 69–82 (2014). https://doi.org/10.1016/S0140-6736(13)60591-7CrossRefPubMed

R.A. Gilhotra, B.T. Rodrigues, V.N. Vangaveti, G. Kan, D. Porter, K.S. Sangla, U.H. Malabu, Non-traumatic lower limb amputation in patients with end-stage renal failure on dialysis: an Australian perspective. Ren. Fail. 38(7), 1036–1043 (2016). https://doi.org/10.1080/0886022X.2016.1193872CrossRefPubMed

P. Kantharidis, B. Wang, R.M. Carew, H.Y. Lan, Diabetes complications: the microRNA perspective. Diabetes 60(7), 1832–1837 (2011). https://doi.org/10.2337/db11-0082CrossRefPubMedPubMedCentral

D.M. Nathan, B. Zinman, P.A. Cleary, J.-Y.C. Backlund, S. Genuth, R. Miller, T.J. Orchard, D. Control, C. Trial, Eo.D. Interventions et al. Modern-day clinical course of type 1 diabetes mellitus after 30 years’ duration: the diabetes control and complications trial/epidemiology of diabetes interventions and complications and Pittsburgh epidemiology of diabetes complications experience (1983–2005). Arch. Intern. Med. 169(14), 1307 (2009). https://doi.org/10.1001/archinternmed.2009.193CrossRefPubMedPubMedCentral

D.R. Group, Diabetes control and complications trial (DCCT): update. Diabetes Care 13(4), 427–433 (1990). https://doi.org/10.2337/diacare.13.4.427CrossRef

D. Control, C.T.R. Group, Effect of intensive diabetes management on macrovascular events and risk factors in the Diabetes Control and Complications Trial. Am. J. Cardiol. 75, 894–903 (1995). https://doi.org/10.1016/s0002-9149(99)80683-3CrossRef

S.A.O. Leite, L.M. Zanim, P.C.D. Granzotto, S. Heupa, R.N. Lamounier, Pontos básicos de um programa de educação ao paciente com diabetes melito tipo 1. Arquivos Brasileiros de Endocrinol. Metab. 52(2), 233–242 (2008). https://doi.org/10.1590/S0004-27302008000200010CrossRef

10.

R.S. Group, Relative effectiveness of insulin pump treatment over multiple daily injections and structured education during flexible intensive insulin treatment for type 1 diabetes: cluster randomised trial (REPOSE). BMJ (2017). https://doi.org/10.1136/bmj.j1285

11.

B. Guerci, Acute complications of insulin pump therapy. Diabetes Res. Clin. Pract. 74, S104–S107 (2006). https://doi.org/10.1016/S0168-8227(06)70009-2CrossRef

12.

A.D. Association, Insulin administration. Diabetes Care 27(suppl 1), s106–s107 (2004). https://doi.org/10.2337/diacare.27.2007.S106CrossRef

13.

S.R. Colberg, R.J. Sigal, J.E. Yardley, M.C. Riddell, D.W. Dunstan, P.C. Dempsey, E.S. Horton, K. Castorino, D.F. Tate, Physical activity/exercise and diabetes: a position statement of the American Diabetes Association. Diabetes Care 39(11), 2065–2079 (2016). https://doi.org/10.2337/dc16-1728CrossRefPubMedPubMedCentral

14.

B.H. McAdams, A.A. Rizvi, An overview of insulin pumps and glucose sensors for the generalist. J. Clin. Med. 5(1), 5 (2016). https://doi.org/10.3390/jcm5010005CrossRefPubMedCentral

15.

J.C. Pickup, Insulin-pump therapy for type 1 diabetes mellitus. N. Engl. J. Med. 366(17), 1616–1624 (2012). https://doi.org/10.1056/NEJMct1113948CrossRefPubMed

16.

M. Tauschmann, R. Hovorka, Technology in the management of type 1 diabetes mellitus—current status and future prospects. Nat. Rev. Endocrinol. 14(8), 464–475 (2018). https://doi.org/10.1038/s41574-018-0044-yCrossRefPubMed

17.

S. Oliveira, C. Neves, C. Esteves, J. Neves, A. Oliveira, M. Pereira, C. Arteiro, A. Costa, M. Redondo, R. Baltazar, Assessing the effects of the transition from multiple daily insulin injections (MDI) to continuous subcutaneous insulin infusion in the intensive treatment of type 1 diabetes mellitus. Revista Portuguesa de Endocrinologia, Diabetes e Metabolismo (2019). www.spedmjournal.com, https://hdl.handle.net/10216/124961

18.

B. Karges, A. Schwandt, B. Heidtmann, O. Kordonouri, E. Binder, U. Schierloh, C. Boettcher, T. Kapellen, J. Rosenbauer, R.W. Holl, 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. JAMA 318(14), 1358–1366 (2017). https://doi.org/10.1001/jama.2017.13994CrossRefPubMedPubMedCentral

19.

E.S. Scott, R.T. McGrath, A.S. Januszewski, D. Calandro, A.A. Hardikar, D.N. O’Neal, G. Fulcher, A.J. Jenkins, HbA1c variability in adults with type 1 diabetes on continuous subcutaneous insulin infusion (CSII) therapy compared to multiple daily injection (MDI) treatment. BMJ Open 9(12), e033059 (2019). https://doi.org/10.1136/bmjopen-2019-033059CrossRefPubMedPubMedCentral

20.

E.A. Doyle, S.A. Weinzimer, A.T. Steffen, J.A.H. Ahern, M. Vincent, W.V. Tamborlane, A randomized, prospective trial comparing the efficacy of continuous subcutaneous insulin infusion with multiple daily injections using insulin glargine. Diabetes Care 27(7), 1554–1558 (2004). https://doi.org/10.2337/diacare.27.7.1554CrossRefPubMed

21.

J. Pickup, Insulin pumps. Diabetes Technol. Ther. 16(S1), S-17–S-22 (2014). https://doi.org/10.1089/dia.2014.1503CrossRef

22.

K. Fuld, B. Conrad, B. Buckingham, D.M. Wilson, Insulin pumps in young children. Diabetes Technol. Ther. 12(S1), S-67–S-71 (2010). https://doi.org/10.1089/dia.2009.0182CrossRef

23.

D.M. Maahs, L.A. Horton, H.P. Chase, The use of insulin pumps in youth with type 1 diabetes. Diabetes Technol. Ther. 12(S1), S-59–S-65 (2010). https://doi.org/10.1089/dia.2009.0161CrossRef

24.

S. Roze, J. Smith‐Palmer, W. Valentine, S. de Portu, K. Nørgaard, J. Pickup, Cost‐effectiveness of continuous subcutaneous insulin infusion versus multiple daily injections of insulin in Type 1 diabetes: a systematic review. Diabetic Med. 32(11), 1415–1424 (2015). https://doi.org/10.1111/dme.12792CrossRefPubMed

25.

P. Ross, J. Milburn, D. Reith, E. Wiltshire, B. Wheeler, Clinical review: insulin pump-associated adverse events in adults and children. Acta Diabetol. 52(6), 1017–1024 (2015). https://doi.org/10.1007/s00592-015-0784-2CrossRefPubMed

26.

R. DeFronzo, A. Stonehouse, J. Han, M. Wintle, Relationship of baseline HbA1c and efficacy of current glucose lowering therapies: a meta‐analysis of randomised clinical trials. Diabetic Med. (2009). https://doi.org/10.1111/j.1464-5491.2010.02941.x

27.

Y. Lebenthal, S. Shalitin, M. Yackobovitch-Gavan, M. Phillip, L. Lazar, Retrospective comparative analysis of metabolic control and early complications in familial and sporadic type 1 diabetes patients. J. Diabetes Complications 26(3), 219–224 (2012). https://doi.org/10.1016/j.jdiacomp.2012.03.016CrossRefPubMed

28.

Y.-H. Lee, M.-H. Shin, H.-S. Nam, K.-S. Park, S.-W. Choi, S.-Y. Ryu, S.-S. Kweon, Effect of family history of diabetes on hemoglobin A1c levels among individuals with and without diabetes: the dong-gu study. Yonsei Med. J. 59(1), 92 (2018). https://doi.org/10.3349/ymj.2018.59.1.92CrossRefPubMed

29.

J.D. Vakharia, S. Agrawal, J. Molino, L.S. Topor, Family history of diabetes is associated with increased risk of recurrent diabetic ketoacidosis in pediatric patients. Endocrine Pract. 26(3), 305–311 (2020). https://doi.org/10.4158/EP-2019-0351CrossRef

30.

S. Šipetić, H. Vlajinac, N. Kocev, J. Marinković, S. Radmanović, L. Denić, Family history and risk of type 1 diabetes mellitus. Acta Diabetol. 39(3), 111–115 (2002). https://doi.org/10.1007/s005920200028CrossRefPubMed

31.

T.A. Armour, S.L. Norris, L. Jack Jr, X. Zhang, L. Fisher, The effectiveness of family interventions in people with diabetes mellitus: a systematic review. Diabetic Med. 22(10), 1295–1305 (2005). https://doi.org/10.1111/j.1464-5491.2005.01618.xCrossRefPubMed

32.

T.-M. Rintala, E. Paavilainen, P. Åstedt-Kurki, Everyday living with diabetes described by family members of adult people with type 1 diabetes. Int. J. Fam. Med. (2013). https://doi.org/10.1155/2013/967872

33.

A.R. Gosmanov, E.O. Gosmanova, A.E. Kitabchi, Hyperglycemic crises: diabetic ketoacidosis (DKA), and hyperglycemic hyperosmolar state (HHS). Endotext (2018). https://doi.org/10.1007/978-1-60327-177-6_6

34.

R. Hanas, J. Ludvigsson, Hypoglycemia and ketoacidosis with insulin pump therapy in children and adolescents. Pediatr. Diabetes 7, 32–38 (2006). https://doi.org/10.1111/j.1399-543X.2006.00169.xCrossRefPubMed

35.

B. Chogtu, R. Magazine, K. Bairy, Statin use and risk of diabetes mellitus. World J. Diabetes 6(2), 352 (2015). https://doi.org/10.4239/wjd.v6.i2.352CrossRefPubMedPubMedCentral

36.

S. Seshadri, N. Rapaka, B. Prajapati, D. Mandaliya, S. Patel, C.S. Muggalla, B. Kapadia, P.P. Babu, P. Misra, U. Saxena, Statins exacerbate glucose intolerance and hyperglycemia in a high sucrose fed rodent model. Sci. Rep. 9(1), 1–9 (2019). https://doi.org/10.1038/s41598-019-45369-8CrossRef

37.

R. Sukhija, S. Prayaga, M. Marashdeh, Z. Bursac, P. Kakar, D. Bansal, R. Sachdeva, S.H. Kesan, J.L. Mehta, Effect of statins on fasting plasma glucose in diabetic and nondiabetic patients. J. Invest. Med. 57(3), 495–499 (2009). https://doi.org/10.2310/JIM.0b013e318197ec8bCrossRef

38.

M. Nakata, S. Nagasaka, I. Kusaka, H. Matsuoka, S. Ishibashi, T. Yada, Effects of statins on the adipocyte maturation and expression of glucose transporter 4 (SLC2A4): implications in glycaemic control. Diabetologia 49(8), 1881–1892 (2006). https://doi.org/10.1007/s00125-006-0269-5CrossRefPubMed

39.

K. Yamazaki, Y. Takahashi, K. Teduka, T. Nakayama, Y. Nishida, S. Asai, Assessment of effect modification of statins on new-onset diabetes based on various medical backgrounds: a retrospective cohort study. BMC Pharmacol. Toxicol. 20(1), 1–10 (2019). https://doi.org/10.1186/s40360-019-0314-xCrossRef

40.

M.T. Jensen, H.U. Andersen, P. Rossing, J.S. Jensen, Statins are independently associated with increased HbA1c in type 1 diabetes–The Thousand & 1 Study. Diabetes Res. Clin. Pract. 111, 51–57 (2016). https://doi.org/10.1016/j.diabres.2015.10.022CrossRefPubMed

41.

G. Scheiner, B.A. Boyer, Characteristics of basal insulin requirements by age and gender in Type-1 diabetes patients using insulin pump therapy. Diabetes Res. Clin. Pract. 69(1), 14–21 (2005). https://doi.org/10.1016/j.diabres.2004.11.005CrossRefPubMed

42.

M. Somali, S.A. Paschou, Z. Mouslech, Insulin pumps use in Greece: efficacy and safety data from 140 patients with type 1 diabetes mellitus. Diabetes Res. Clin. Pract. 160, 108026 (2020). https://doi.org/10.1016/j.diabres.2020.108026CrossRefPubMed

43.

B. Matejko, B. Kiec‐Wilk, M. Szopa, I. Trznadel Morawska, M.T. Malecki, T. Klupa, Are late‐night eating habits and sleep duration associated with glycemic control in adult type 1 diabetes patients treated with insulin pumps? J. Diabetes Invest. 6(4), 460–464 (2015). https://doi.org/10.1111/jdi.12320CrossRef

44.

Z.M. Nabhan, L. Rardin, J. Meier, E.A. Eugster, L.A. DiMeglio, Predictors of glycemic control on insulin pump therapy in children and adolescents with type I diabetes. Diabetes Res. Clin. Pract. 74(3), 217–221 (2006). https://doi.org/10.1111/j.1464-5491.2010.03068.xCrossRefPubMed

45.

J. Wilkinson, K. McFann, H. Chase, Factors affecting improved glycaemic control in youth using insulin pumps. Diabetic Med. 27(10), 1174–1177 (2010). https://doi.org/10.1111/j.1464-5491.2010.03068.xCrossRefPubMed

46.

C.A. Paris, G. Imperatore, G. Klingensmith, D. Petitti, B. Rodriguez, A.M. Anderson, I.D. Schwartz, D.A. Standiford, C. Pihoker, Predictors of insulin regimens and impact on outcomes in youth with type 1 diabetes: the SEARCH for Diabetes in Youth study. J. Pediatr. 155(2), 183–189 (2009). https://doi.org/10.1016/j.jpeds.2009.01.063. e181CrossRefPubMed

47.

R. Hanas, P. Adolfsson, Insulin pumps in pediatric routine care improve long‐term metabolic control without increasing the risk of hypoglycemia. Pediatr. Diabetes 7(1), 25–31 (2006). https://doi.org/10.1111/j.1399-543X.2006.00145.xCrossRefPubMed

48.

R.S. Mecklenburg, E.A. Benson, J.W. Benson, P.N. Fredlund, T. Guinn, R.J. Metz, R.L. Nielsen, C.A. Sannar, Acute complications associated with insulin infusion pump therapy: report of experience with 161 patients. JAMA 252(23), 3265–3269 (1984). https://doi.org/10.1001/jama.1984.03350230025026CrossRefPubMed

49.

A.J. Flatt, S.A. Little, J. Speight, L. Leelarathna, E. Walkinshaw, H.K. Tan, A. Bowes, A. Lubina-Solomon, E. Holmes-Truscott, T.J. Chadwick, Predictors of recurrent severe hypoglycemia in adults with type 1 diabetes and impaired awareness of hypoglycemia during the HypoCOMPaSS study. Diabetes Care 43(1), 44–52 (2020). https://doi.org/10.2337/dc19-0630CrossRefPubMed

50.

U. Pedersen‐Bjergaard, S. Pramming, S.R. Heller, T.M. Wallace, Å.K. Rasmussen, H.V. Jørgensen, D.R. Matthews, P. Hougaard, B. Thorsteinsson, Severe hypoglycaemia in 1076 adult patients with type 1 diabetes: influence of risk markers and selection. Diabetes Metab. Res. Rev. 20(6), 479–486 (2004). https://doi.org/10.1002/dmrr.482CrossRefPubMed

51.

M. Phillip, T. Battelino, H. Rodriguez, T. Danne, F. Kaufman, Use of insulin pump therapy in the pediatric age-group: consensus statement from the European Society for Paediatric Endocrinology, the Lawson Wilkins Pediatric Endocrine Society, and the International Society for Pediatric and Adolescent Diabetes, endorsed by the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 30(6), 1653–1662 (2007). https://doi.org/10.2337/dc07-9922. https://doi.org/10.1097/00004583-199805000-00016

52.

D.S. Liss, D.A. Waller, B.D. Kennard, D. McINTIRE, P. Capra, J. Stephens, Psychiatric illness and family support in children and adolescents with diabetic ketoacidosis: a controlled study. J. Am. Acad. Child Adolesc. Psychiatry 37(5), 536–544 (1998). https://doi.org/10.1097/00004583-199805000-00016

53.

P.J. Lustman, G.W. Harper, L.S. Griffith, R.E. Clouse, Use of the diagnostic interview schedule in patients with diabetes mellitus. J. Nerv. Ment. Dis. (1986). https://doi.org/10.1097/00005053-198612000-00006

Title: Predictors of the effectiveness of insulin pumps in patients with type 1 diabetes mellitus
Authors: Joana Camões Neves
João Sérgio Neves
Celestino Neves
Davide Carvalho
Publication date: 01-01-2022
Publisher: Springer US
Keywords: Statins
Insulins
Ketoacidosis
Hypoglycemia
Diabetes
Insulins
Type 1 Diabetes
Published in: Endocrine / Issue 1/2022
Print ISSN: 1355-008X
Electronic ISSN: 1559-0100
DOI: https://doi.org/10.1007/s12020-021-02837-4

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Predictors of the effectiveness of insulin pumps in patients with type 1 diabetes mellitus

Abstract

Purpose

Methods

Results

Conclusion

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2022

Incidence and predictive factors of postoperative hypocalcaemia according to type of thyroid surgery in older adults

A novel in vitro assay to study chondrocyte-to-osteoblast transdifferentiation

Surgical outcome of transsphenoidal surgery in Cushing’s disease: a case series of 1106 patients from a single center over 30 years

Blood glucose and epicardial adipose tissue at the hospital admission as possible predictors for COVID-19 severity

Low sclerostin levels after long-term remission of acromegaly

Elevated thyroid-stimulating hormone levels are associated with poor sleep: a cross-sectional and longitudinal study

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page