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Insulin pump therapy improves outcomes vs. insulin injections

Research published in JAMA suggested that insulin pump therapy, when compared with insulin injections, was associated with a lower risk for diabetic ketoacidosis and severe hypoglycemia in patients with type 1 diabetes who were younger than 20 years.

According to study background, insulin pump use for intensive insulin therapy among patients with type 1 diabetes substantially increased from 0.6% to 1.3% in 1995 to 44% to 47% between 2012 and 2016.

“The association of pump therapy with the risk of acute diabetes complications has not been comprehensively studied in direct comparison to injection therapy, because evaluating rare events such as severe hypoglycemia and ketoacidosis requires adequately sized large datasets,” Beate Karges, MD, of the division of endocrinology and diabetes at the RWTH Aachen University in Germany, and colleagues wrote.

Researchers studied patients with type 1 diabetes for longer than a year who were younger than 20 years (mean age, 14.1 years). Patients using pump therapy (n = 9,814) were matched 1:1 with those using injection therapy.

Researchers performed propensity score matching and inverse probability of treatment weighting analyses. They used covariates including age, BMI, diabetes duration, glycated hemoglobin, migration background (defined as birth place outside of Austria or Germany) and sex to account for relevant confounders.

Primary outcomes were diabetic ketoacidosis and severe hypoglycemia rates during the patient’s most recent year of treatment. Secondary outcomes included BMI, glycated hemoglobin levels and insulin dose.

According to results, pump therapy, when compared with injection therapy, was significantly linked to lower rates of severe hypoglycemia (9.55 vs. 13.97 per 100 patient-years; difference, –4.42; 95% CI, –6.15 to –2.69) and diabetic ketoacidosis (3.64 vs. 4.26 per 100 patient-years; difference, –0.63; 95% CI, –1.24 to –0.02).

In addition, glycated hemoglobin levels were significantly lower with pump therapy than with injection therapy (8.04% vs. 8.22%; difference, 0.18; 95% CI, –0.22 to –0.13), as was total daily insulin doses (0.84 U/kg vs. 0.98 U/kg; difference, –0.14; 95% CI, –0.15 to –0.13).

Researchers reported no significant difference in BMI between groups.

After propensity score inverse probability of treatment weighting analyses, researchers found similar results for the entire cohort.

“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,” Karges and colleagues wrote. - by Janel Miller

Disclosures : Karges reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.