HbA1c variability in adults with type 1 diabetes on continuous subcutaneous insulin infusion (CSII) therapy compared to multiple daily injection (MDI) treatment.

ABSTRACT: Objective:To determine if continuous subcutaneous insulin infusion (CSII) therapy is associated with lower glycated haemoglobin (HbA1c) variability (long-term glycaemic variability; GV) relative to multiple daily injection (MDI) treatment in adults with type 1 diabetes mellitus (T1DM).

Design:Retrospective audit.

Setting and participants:Clinic records from 506 adults with T1DM from two tertiary Australian hospitals.

Outcome measures:Long-term GV was assessed by HbA1c SD and coefficient of variation (CV) in adults on established MDI or CSII therapy, and in a subset changing from MDI to CSII.

Results:Adults (n=506, (164 CSII), 50% women, mean±SD?age 38.0±15.3?years, 17.0±13.7?years diabetes, mean HbA1c 7.8%±1.2% (62±13?mmol/mol) on CSII, 8.0%±1.5% (64±16?mmol/mol) on MDI) were followed for 4.1±3.6?years. CSII use was associated with lower GV (HbA1c SD: CSII vs MDI 0.5%±0.41% (6±6?mmol/mol) vs 0.7%±0.7% (9±8?mmol/mol)) and CV: CSII vs MDI 6.7%±4.6% (10±10?mmol/mol) vs 9.3%±7.3% (14±13?mmol/mol), both p<0.001. Fifty-six adults (73% female, age 36±13?years, 16±13?years diabetes, HbA1c 7.8%±0.8% (62±9?mmol/mol)) transitioned from MDI to CSII. Mean HbA1c fell by 0.4%. GV from 1?year post-CSII commencement decreased significantly, HbA1c SD pre-CSII versus post-CSII 0.7%±0.5% (8±5?mmol/mol) vs 0.4%±0.4% (5±4?mmol/mol); p<0.001, and HbA1c CV 9.2%±5.5% (13±8?mmol/mol) vs 6.1%±3.9% (9±5?mmol/mol); p<0.001.

Conclusions:In clinical practice with T1DM adults relative to MDI, CSII therapy is associated with lower HbA1c GV.

SUBMITTER: Scott ES 

PROVIDER: S-EPMC6937034 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature