Glycemic control and weight outcomes after initiation of continuous subcutaneous insulin infusion therapy

Abstract

Introduction The continuous subcutaneous insulin infusion (CSII) is an alternative to multiple daily injections therapy in type 1 diabetes and its use is increasingly common due to the beneficial effects on glucose control. Aims To analyze clinical features and biochemical parameters of patients on CSII therapy. Type of study Longitudinal retrospective. Setting Outpatient clinic. Population: Type 1 diabetic patients using insulin infusion pump in our department. Methods We evaluated outcomes regarding the following set points: immediately before initiation of CSII therapy, 12 months after inclusion and in the last appointmentHH. For statistical analysis, we used non-parametric tests and linear regression analysis. We considered significant a value of p0.05. Results We studied 63 patients (24 men; 39 women) with a mean pre-CSII HbA1c of 8.2% ± 1.43; mean age at the time of placement of 32.7 ± 10.94 years; and mean follow up time after placement of 2.1 ± 1.92 years. There was a statistically significant reduction of HbA1c during follow-up (HbA1c 12 months: 7.2% [6.67.8] p = 0.001; HbA1c at the end of follow-up: 7.4% [6.67.9] p = 0,001). There was no significant variation of weight or total daily insulin dose. We registered a negative correlation between the last HbA1c before CSII and the reduction in HbA1c until the end of the follow-up period (=0.644 p = 0.000). The median reduction in HbA1c was higher in women (W: 1.10 [2.200.40] vs M: 0.10 [0.800.40]; p = 0.002). Female gender was a predictive factor of better results with CSII, even after adjustment to the last HbA1c before the initiation of therapy. Conclusions In our sample, the last HbA1c before the beginning of CSII was the most powerful predictive factor of the reduction of HbA1c during follow up. Women had better results than men. There was no significant variation of weight and total daily insulin dose during follow up.