Insulin pumps found to be beneficial in youth with type 1 diabetes

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Takeaway

  • Insulin pump therapy may significantly benefit children and teenagers with type 1 diabetes (T1D).  

Why this matters

  • Improved glycemic control is associated with fewer long-term diabetes complications.

Study design

  • Total study population comprised 14,119 patients with T1D (age, <20 y) using insulin pumps; 16,460 receiving ≥4 daily insulin injections; 350 European diabetes centers.
  • Propensity matching paired 9814 patients from each group by age, sex, diabetes duration, migration background, BMI, HbA1c.
  • Funding: German Federal Ministry of Education and Research; European Foundation for the Study of Diabetes.

Key results

  • For severe hypoglycemia and hypoglycemic coma, significantly lower event rates with pump vs injections (9.55 vs 13.97/100 patient-y [incidence rate ratio, IRR, 0.68; all 95% CI 0.59-0.79] and 2.30 vs 2.96/100 patient-y [IRR, 0.78; 0.62-0.97], respectively).
  • Differences remained significant after multiple comparisons adjustment (P<.001, P=.03, respectively).
  • Lower overall and severe diabetic ketoacidosis rates with pump vs injections (3.64 vs 4.26/100 patient-y [IRR, 0.85; 0.73-0.995] and 2.29 vs 2.80/100 patient-y [IRR, 0.82; 0.68-0.99], respectively).
  • Significantly lower overall HbA1c with pump therapy (8.04% vs 8.22%; P<.001), except for children 1.5-5 y.

Limitations

  • Nonrandomized, observational.
  • Individual factors (eg, education, motivation, family support) not addressed.
  • Pump use duration, discontinuation, use of continuous glucose monitoring not addressed.