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Year: 2009

Abstract Number: 1006-P


Institutions: Aurora, CO

Results: Previous studies have reported that insulin pump therapy (P) of type 1 diabetes (T1D) results in lower HbA1c (A1C) and lower daily insulin dose (ID) than multiple daily injections (I), but may cause weight gain. The purpose of this study was to examine changes in A1c, ID and body mass index (BMI) in adults with T1D transitioning between P and I therapy outside of a context of clinical trial and over an extended time.
198 men and 233 women (baseline age, 19-56 yrs) with T1D (duration, 23.6± 9.0 yrs) completed three visits(v1,v2,v3) over 6.1 ± 0.5 years. They were grouped into: I = injections at all visits; P = pump at all visits; I to P = injection V1 to pump V3; and P to I = pump V1 to injections V3. Baseline A1c, ID and BMI and changes (Δ) from V1 to V3 were analyzed using general linear modeling (table).

Baseline Insulin Dose, HbA1c, and BMI and Change over Time, by Insulin Treatment Mode
I n=176P n=134I to Pn=77P to In=30
HbA1c, %8.17.6*7.97.9
Δ HbA1c, %-0.00.3*-0.2-0.5
ID, U/kg/d0.700.44**0.670.50**
Δ ID, U/kg/d0.010.09**-0.16**0.12*
BMI, kg/m226.425.826.425.7
Δ BMI, kg/m20.641.040.220.39
Adjusted for sex, age and duration of diabetes. * p < 0.05, ** p<0.001 for t-test within each group for versus the I groupBaseline A1c was lowest in the P group and significantly different from the I group, however, the P group experienced significant A1c increase, despite a parallel increase in ID. Still, the P group had the lowest ID at V1 and V3. ID decreased in the I to P group and increased by about the same amount in the P to I group. P patients who increased their A1c (n=90) were not different in terms of changes in ID or BMI from the P group who maintained or lowered their A1c (n=40). BMI was similar across the groups and, while it has increased slightly in all groups, the increase was not significant.
In conclusion, insulin pump treatment is usually more effective than injections in achieving better A1c with lower daily ID and no adverse weight gain. However, a subset of pump patients may experience worsening of A1c despite increasing ID. While this may reflect regression to the mean, these patients may benefit from additional counseling.

Category: Epidemiology