TY - JOUR

T1 - Effects of initiating insulin pump therapy in the real world

T2 - A nationwide, register-based study of adults with type 1 diabetes

AU - Madsen, Kristoffer P.

AU - Olsen, Kim R.

AU - Rytter, Karen

AU - Willaing, Ingrid

AU - Pedersen-Bjergaard, Ulrik

AU - Schmidt, Signe

AU - Norgaard, Kirsten

AU - Kjer, Trine

PY - 2023

Y1 - 2023

N2 - Aims: We aimed to estimate effects of insulin pump therapy (IPT) on HbA1c level, HbA1c variability, and risk of hospitalised diabetic ketoacidosis (DKA) and severe hypoglycaemia (SH), compared with multiple daily insulin injections (MDI).Methods: We identified a cohort of all adults with type 1 diabetes in Denmark using national registry data and assigned each individual to either IPT (treatment) or MDI (control) from 2010 to 2020. We estimated average treatment effects on the treated (ATT) and treatment effects among population subgroups using treatment-staggered difference-in-differences.Results: The cohort consisted of 26,687 individuals with a collective 243,601 person-years of observation; 38,823 (16 %) were IPT person-years. We identified an ATT for HbA1c of-0.33 % (95 % CI-0.39 to-0.27;-3.6 mmol/ mol [95 % CI-4.2 to-2.9]). ATTs were larger among women and individuals who were older, had highest baseline HbA1c, and used continuous glucose monitoring. ATT for HbA1c variability (-0.016 % [-0.028 to-0.0041);-0.17 mmol/mol [95 % CI-0.30 to-0.045]) corresponded to a 6.5 % decrease in the standard deviation of HbA1c. ATTs for DKA and SH corresponded to 0.52 additional and 0.11 fewer hospitalisations per 1,000 person-years, respectively.Conclusions: IPT significantly reduced HbA1c level and variability, compared with MDI. However, it also marginally increased the risk of hospitalised DKA.

AB - Aims: We aimed to estimate effects of insulin pump therapy (IPT) on HbA1c level, HbA1c variability, and risk of hospitalised diabetic ketoacidosis (DKA) and severe hypoglycaemia (SH), compared with multiple daily insulin injections (MDI).Methods: We identified a cohort of all adults with type 1 diabetes in Denmark using national registry data and assigned each individual to either IPT (treatment) or MDI (control) from 2010 to 2020. We estimated average treatment effects on the treated (ATT) and treatment effects among population subgroups using treatment-staggered difference-in-differences.Results: The cohort consisted of 26,687 individuals with a collective 243,601 person-years of observation; 38,823 (16 %) were IPT person-years. We identified an ATT for HbA1c of-0.33 % (95 % CI-0.39 to-0.27;-3.6 mmol/ mol [95 % CI-4.2 to-2.9]). ATTs were larger among women and individuals who were older, had highest baseline HbA1c, and used continuous glucose monitoring. ATT for HbA1c variability (-0.016 % [-0.028 to-0.0041);-0.17 mmol/mol [95 % CI-0.30 to-0.045]) corresponded to a 6.5 % decrease in the standard deviation of HbA1c. ATTs for DKA and SH corresponded to 0.52 additional and 0.11 fewer hospitalisations per 1,000 person-years, respectively.Conclusions: IPT significantly reduced HbA1c level and variability, compared with MDI. However, it also marginally increased the risk of hospitalised DKA.

KW - Type 1 diabetes mellitus

KW - Insulin pump therapy

KW - Continuous subcutaneous insulin infusion

KW - Glycaemic outcomes

KW - Real-world data

KW - Quasi-experimental study

KW - Treatment staggered difference-in-differences

KW - GLYCEMIC CONTROL

KW - INFUSION

KW - INJECTIONS

KW - RISK

U2 - 10.1016/j.diabres.2022.110225

DO - 10.1016/j.diabres.2022.110225

M3 - Journal article

C2 - 36535513

VL - 196

JO - Diabetes Research and Clinical Practice. Supplement

JF - Diabetes Research and Clinical Practice. Supplement

SN - 1572-1671

M1 - 110225

ER -