Compared to insulin injections, insulin pump therapy among patients younger than 20 years old with type 1 diabetes was associated with a lower risk of diabetic ketoacidosis and severe hypoglycemia and with better glycemic control during the most recent year of therapy, a study found.
The population-based cohort study was conducted between January 2011 and December 2015 at 446 centers in Germany, Austria, and Luxembourg. The study population included children, adolescents, and young adults who had had type 1 diabetes for more than a year. Of the 30,579 patients (mean age, 14.1 years; 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=9,814) were matched 1:1 to patients using injection therapy. Results were published Oct. 10 by JAMA.
Pump therapy was associated with lower rates of both primary outcomes: severe hypoglycemia (9.55 vs. 13.97 per 100 patient-years; difference, −4.42 [95% CI, −6.15 to −2.69]; P<0.001) and diabetic ketoacidosis (3.64 vs. 4.26 per 100 patient-years; difference, −0.63 [95% CI, −1.24 to −0.02]; P=0.04). HbA1c levels were also lower with pump therapy than with injection therapy (8.04% vs. 8.22%; difference, −0.18 [95% CI, −0.22 to −0.13]; P<0.001), as were total daily insulin doses (0.84 U/kg vs 0.98 U/kg; difference, −0.14 [95% CI, −0.15 to −0.13]; P<0.001). There was no significant difference in body mass index between the regimens.
The authors noted that their findings provide evidence for improved clinical outcomes associated with insulin pump therapy compared with injection therapy in a younger population.
“Recent clinical trials have shown that sensor-responsive insulin delivery may optimize glycemic control by increasing time within target range of glucose concentrations,” the authors wrote. “Results of this study provide further evidence that insulin pump therapy, which is a core element of artificial beta cell technology, is safe and effective, even in routine diabetes care for unselected patients at a population-based level.”