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Endocrine

, Volume 48, Issue 1, pp 164–169 | Cite as

Factors associated with glycemic control in adult type 1 diabetes patients treated with insulin pump therapy

  • Bartłomiej Matejko
  • Jan Skupien
  • Sandra Mrozińska
  • Małgorzata Grzanka
  • Katarzyna Cyganek
  • Beata Kiec-Wilk
  • Maciej T. Malecki
  • Tomasz Klupa
Original Article

Abstract

Continuous subcutaneous insulin infusion (CSII) by insulin pump seems to improve glycemia and quality of life as compared to conventional insulin therapy in type 1 diabetes (T1DM). However, while many T1DM subjects achieve excellent glycemic control, some others cannot reach recommended goals. In a retrospective analysis, we searched for factors associated with glycemic control in T1DM patients treated with insulin pump therapy. Data from 192 patients (133 women and 59 men) treated with personal insulin pumps at the Department of Metabolic Diseases, University Hospital, Krakow, Poland were analyzed. Sources of information included medical records, memory read-outs from insulin pumps and data from glucose meters. Univariate, multivariate linear and logistic regression analysis for the association with hemoglobin A1c (HbA1c) level were performed. The mean age of the subjects was 28.9 (±11.2) years, the mean duration of T1DM—14.6 (±7.6) years, mean body mass index—23.5 (±3.1) kg/m2. The mean HbA1c level in the entire study group was 7.4 % (57 mmol/mol). In the multivariate linear regression analysis, HbA1c correlated with the mean number of daily blood glucose measurements, number of hypoglycemic episodes per 100 blood glucose measurements, age at the examination, and continuous glucose monitoring system use. Multivariate logistic regression analysis for reaching the therapeutic target of HbA1c < 7.0 % (53 mmol/mol) showed that the independent predictors of achieving this goal included the same four variables. In a large clinical observation, we identified that patient-related and technological factors associated with glycemic control in adult pump-treated T1DM subjects.

Keywords

Type 1 diabetes mellitus Insulin pump HbA1c 

Notes

Acknowledgments

The authors are grateful to Ms Aleksandra Malecka (Warsaw University) for her editorial and linguistic assistance.

Conflict of interest

Bartłomiej Matejko, Tomasz Klupa received payments for lectures from Medtronic. Katarzyna Cyganek received travel grants from Medtronic and Willcare.

Ethical standards

This observational research complies with the current laws of Poland.

References

  1. 1.
    The Diabetes Control and Complications Trial Research Group, The effect of intensive treatment of diabetes on the development and progression of long term complications in insulin-dependent diabetes mellitus. N. Engl. J. Med. 329, 977–986 (1993)CrossRefGoogle Scholar
  2. 2.
    DCCT/EDIC Study Research Group, Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N. Engl. J. Med. 353, 2643–2653 (2005)CrossRefGoogle Scholar
  3. 3.
    K. Jeitler, K. Horvath, A. Berghold, T.Z. Gratzer, K. Neeser, T.R. Pieber, A. Siebenhofer, Continuous subcutaneous insulin infusion versus multiple daily insulin injections in patients with diabetes mellitus: systematic review and meta-analysis. Diabetologia 51, 941–951 (2008)CrossRefPubMedGoogle Scholar
  4. 4.
    M.I. Maiorino, G. Bellastella, M. Petrizzo, M.R. Improta, C. Brancario, F. Castaldo, L. Olita, D. Giugliano, K. Esposito, Treatment satisfaction and glycemic control in young Type 1 diabetic patients in transition from pediatric health care: CSII versus MDI. Endocrine (2013). doi: 10.1007/s12020-013-0060-6
  5. 5.
    R. Retnakaran, J. Hochman, J. DeVries, H. Hanaire-Broutin, R.J. Heine, V. Melki, B. Zinman, Continuous subcutaneous insulin infusion versus multiple daily injections. Diabetes Care 11, 2590–2596 (2004)CrossRefGoogle Scholar
  6. 6.
    M.L. Misso, K.J. Egberts, M. Page, D. O’Connor, J. Shaw, Continuous subcutaneous insulin infusion (CSII) versus multiple insulin injections for type 1 diabetes mellitus. Cochrane Database Syst Rev 1, CD005103 (2008)Google Scholar
  7. 7.
    Polish Diabetes Association, Clinical recommendations for the management of patients with diabetes. Clin. Diabetol. 2(Suppl A), 3–52 (2013)Google Scholar
  8. 8.
    T. Cukierman-Yaffe, N. Konvalina, O. Cohen, Key elements for successful intensive insulin pump therapy in individuals with type 1 diabetes. Diabetes Res. Clin. Pract. 92, 69–73 (2011)CrossRefPubMedGoogle Scholar
  9. 9.
    American Diabetes Association, Standards of medical care in diabetes 2011. Diabetes Care 34(Suppl 1), 11–61 (2011)CrossRefGoogle Scholar
  10. 10.
    R.M. Bergenstal, W.V. Tamborlane, A. Ahmann, J.B. Buse, G. Dailey, S.N. Davis, C. Joyce, T. Peoples, B.A. Perkins, J.B. Welsh, S.M. Willi, M.A. Wood, STAR 3 Study Group: effectiveness of sensor-augmented insulin-pump therapy in type 1 diabetes. N. Engl. J. Med. 22(363), 311–320 (2010)CrossRefGoogle Scholar
  11. 11.
    R.L. Brazg, T.S. Bailey, S. Garg, B.A. Buckingham, R.H. Slover, D.C. Klonoff, X. Nguyen, J. Shin, J.B. Welsh, S.W. Lee, The ASPIRE study: design and methods of an in-clinic crossover trial on the efficacy of automatic insulin pump suspension in exercise-induced hypoglycemia. J. Diabetes Sci. Technol. 1(5), 1466–1471 (2011)CrossRefGoogle Scholar
  12. 12.
    S. Schmidt, K. Nørgaard, Sensor-augmented pump therapy at 36 months. Diabetes Technol. Ther. 14, 1174–1177 (2012)CrossRefPubMedGoogle Scholar
  13. 13.
    G. Lepore, A.R. Dodesini, I. Nosari, C. Scaranna, A. Corsi, R. Trevisan, Bolus calculator improves long term metabolic control and reduces glucose variability in pump treated patients with Type 1 diabetes. Nutr. Metab. Cardiovasc. Dis. 22, 15–16 (2012)CrossRefGoogle Scholar
  14. 14.
    Health Quality Ontario, Continuous subcutaneous insulin infusion (CSII) pumps for Type 1 and Type 2 adult diabetic populations. An evidence-based analysis. Ont. Health Technol. Assess. Ser. 9, 1–58 (2009)Google Scholar
  15. 15.
    E.M. Gerstl, W. Rabl, J. Rosenbauer, H. Grobe, S.E. Hofer, U. Krause, R.W. Holl, Metabolic control as reflected by HbA1c in children, adolescents and young adults with type-1 diabetes mellitus: combined longitudinal analysis including 27,035 patients from 207 centers in Germany and Austria during the last decade. Eur. J. Pediatr. 167, 447–453 (2008)CrossRefPubMedGoogle Scholar
  16. 16.
    R. Ziegler, B. Heidtmann, D. Hilgard, S. Hofer, J. Rosenbauer, R. Holl, DPV-Wiss-Initiative: frequency of SMBG correlates with HbA1c and acute complications in children and adolescents with type 1 diabetes. Pediatr. Diabetes 12, 11–17 (2011)CrossRefPubMedGoogle Scholar
  17. 17.
    A. Schiffrin, M. Belmonte, Multiple daily self glucose monitoring: its essential role in long term glucose control in insulin-dependent diabetic patients treated with pump and multiple subcutaneous injections. Diabetes Care 5, 479–484 (1982)CrossRefPubMedGoogle Scholar
  18. 18.
    B. Bode, R.W. Beck, D. Xing, L. Gilliam, I. Hirsch, C. Kollman, L. Laffel, K.J. Ruedy, W.V. Tamborlane, S. Weinzimer, H. Wolpert, Sustained benefit of continuous glucose monitoring on A1C, glucose profiles, and hypoglycemia in adults with type 1 diabetes. Diabetes Care 32, 2047–2049 (2009)CrossRefPubMedGoogle Scholar
  19. 19.
    L.K. Gilliam, I.B. Hirsch, Practical aspects of real-time continuous glucose monitoring. Diabetes Technol. Ther. 11, 75–82 (2009)CrossRefGoogle Scholar
  20. 20.
    A.E. Scaramuzza, D. Iafusco, I. Rabbone, R. Bonfanti, F. Lombardo, R. Schiaffini, P. Buono, S. Toni, V. Cherubini, G.V. Zuccotti, Use of integrated real-time continuous glucose monitoring/insulin pump system in children and adolescents with type 1 diabetes: a 3-year follow-up study. Diabetes Technol. Ther. 13, 99–103 (2011)CrossRefPubMedGoogle Scholar
  21. 21.
    J.B. Buse, G. Dailey, A. Ahmann, R.M. Bergenstal, J.B. Green, T. Peoples, R.J. Tanenberg, Q. Yang, Baseline predictors of A1C reduction in adults using sensor-augmented pump therapy or multiple daily injection therapy: the STAR 3 experience. Diabetes Technol. Ther. 13, 601–606 (2011)CrossRefPubMedCentralPubMedGoogle Scholar
  22. 22.
    N. Mauras, L. Fox, K. Englert, R.W. Beck, Continuous glucose monitoring in type 1 diabetes. Endocrine 43, 41–50 (2013)CrossRefPubMedGoogle Scholar
  23. 23.
    R.M. Bergenstal, D.C. Klonoff, S.K. Garg, B.W. Bode, M. Meredith, R.H. Slover, A.J. Ahmann, J.B. Welsh, S.W. Lee, F.R. Kaufman, Threshold-based insulin-pump interruption for reduction of hypoglycemia. N. Engl. J. Med. 369, 224–232 (2013)CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Bartłomiej Matejko
    • 1
  • Jan Skupien
    • 1
    • 2
  • Sandra Mrozińska
    • 1
  • Małgorzata Grzanka
    • 1
  • Katarzyna Cyganek
    • 2
  • Beata Kiec-Wilk
    • 1
    • 2
  • Maciej T. Malecki
    • 1
    • 2
  • Tomasz Klupa
    • 1
    • 2
  1. 1.Department of Metabolic Diseases, Jagiellonian University Medical CollegeJagiellonian UniversityKrakówPoland
  2. 2.University HospitalKrakówPoland

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