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Predictors of the effectiveness of insulin pumps in patients with type 1 diabetes mellitus

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Abstract

Purpose

Insulin pump therapy has become the preferential treatment for type 1 diabetes (T1D) as it mimics the physiological secretion of insulin better than multiple daily injections. However, not all patients improve with insulin pump therapy. This study aims to determine the predictors of the effectiveness of insulin pumps in T1D.

Methods

We conducted a retrospective observational study of patients who started insulin pumps. Data from four timepoints (before, at 6, 12, and 36 months) were evaluated for outcomes of glycemic control and safety. The association of baseline predictors with outcomes was analyzed using linear and logistic regression models.

Results

We evaluated 136 patients (57.4% females, age 36 ± 12 years, duration of T1D 14 ± 9 years). During the follow-up, there was a mean decrease of HbA1c of 0.9 ± 1.2%. The improvement in HbA1c was independent of sex, age, and duration of T1D. Higher baseline HbA1c, family history of diabetes, and not being treated with statins were predictors of improvement in HbA1c. Not being treated with statins and higher baseline HbA1c predicted improvement in HbA1c without worsening hypoglycemia. History of hypoglycemia was a predictor of severe hypoglycemia. Family history, higher baseline HbA1c, and psychological/psychiatric disorders were predictors of ketoacidosis.

Conclusion

Benefits of insulin pump were independent of sex, age, and duration of T1D. Baseline HbA1c, family history of diabetes, treatment with statins, history of hypoglycemia, and psychological/psychiatric disorders were predictors of outcomes, and may allow the identification of patients who benefit most from insulin pump therapy or who are at increased risk of complications.

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Data availability

The datasets analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request.

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Acknowledgements

We gratefully acknowledge the Department of Endocrinology, Diabetes, and Metabolism of Centro Hospitalar Universitário São João for allowing this study to be carried out, providing technical and consultancy support.

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Authors and Affiliations

  1. Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal

    Joana Camões Neves, João Sérgio Neves, Celestino Neves & Davide Carvalho

  2. Faculty of Medicine, University of Porto, Porto, Portugal

    Joana Camões Neves, João Sérgio Neves, Celestino Neves & Davide Carvalho

  3. Department of Surgery and Physiology, Cardiovascular Research Unit, Faculty of Medicine, University of Porto, Porto, Portugal

    João Sérgio Neves

  4. Institute for Research and Innovation in Health Sciences, University of Porto, Porto, Portugal

    João Sérgio Neves, Celestino Neves & Davide Carvalho

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  1. Joana Camões Neves
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Contributions

All authors contributed to the study conception. J.C.N.: study design, manuscript design and conception, acquisition and interpretation of data, work draft and critical review, final approval of the manuscript; J.S.N.: study design, manuscript design and conception, analysis and interpretation of data, work draft and critical review, final approval of the manuscript; C.N.: work draft and critical review, final approval of the manuscript; D.C.: work draft and critical review, final approval of the manuscript.

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Correspondence to Joana Camões Neves.

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Neves, J.C., Neves, J.S., Neves, C. et al. Predictors of the effectiveness of insulin pumps in patients with type 1 diabetes mellitus. Endocrine 75, 119–128 (2022). https://doi.org/10.1007/s12020-021-02837-4

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