Better Glycaemic Outcome, Low Levels of Acute Severe Complications, and High Patient Satisfaction in Routine Practice in Type 1 Diabetes Treated with an Insulin Pump

Abstract

Treatment of patients with Type 1 diabetes with continuous subcutaneous insulin infusion (CSII) was re-introduced in Denmark in this millennium and initiated in the diabetes clinic, Fredericia Hospital, in 2005. The aim of the present study was to present yearly data of quality from 2005 to 2013 from a clinical database of patients treated with CSII in routine practice. Methods: A database was established in 2009-2010. Data from 2005 to 2009 are retrospective, data from 2009 to 2013 prospective. From 2009, patient satisfaction was measured by validated questionnaires. Results: By 31 December 2013, the database contained data from 143 active patients. HbA1C (median and range) decreased from 64 (40 - 126) mmol/mol (8.0 (5.8 - 13.7)%) (n = 104) to 60 (36 - 98) mmol/mol (7.6 (5.4 - 11.1)%) (n = 134) (p < 0.001) before and latest year on CSII. The improved glycaemic control was maintained each year until ≥5 years after initiation of CSII (p < 0.01). There was no change in weight. The number of attacks of severe hypoglycaemia was reduced from 60 attacks in 21 patients (n = 104) the year before CSII to only 5 attacks in 5 patients in 2013 (n = 134) (p < 0.01), corresponding to an incidence of 3.7 episodes per 100 patient years. Each year after initiation of CSII until ≥5 years, the number of episodes of severe hypoglycaemia was reduced (p < 0.01). Since 2005, nine episodes of ketoacidosis have been registered in eight patients corresponding to an incidence of 1.4 episodes per 100 patient years. Patient satisfaction was high one year after initiation of CSII (p < 0.01). Conclusion: Change of treatment to CSII is accompanied by an improvement in glycaemic control, very pronounced reduction in severe hypoglycaemia, low levels of diabetic ketoacidosis, and pronounced patient satisfaction.