The Impact of Insulin Pump Therapy on Glycemic Control and Acute Diabetes Complications in Type 1 Diabetes: Real-World Evidence From a Single Center

TL;DR

This study shows that insulin pump therapy improves blood sugar control and reduces diabetes complications in type 1 diabetes patients compared to traditional insulin injections.

Contribution

The study provides real-world evidence of improved glycemic control and reduced acute complications with insulin pump therapy in a single clinical center.

Findings

Insulin pump therapy significantly improved HbA1c/GMI levels and time spent in target glucose range.

There was a notable reduction in hypoglycemia frequency and diabetic ketoacidosis admissions.

Patients experienced greater mealtime flexibility and better overall quality of life.

Abstract

Background and objectives

The adoption of insulin pumps in diabetes management has seen a significant rise globally, offering promising advancements in glycemic control. Despite this progress, notable disparities remain in the utilization of this technology across different populations. We hypothesized that insulin pump therapy improves glycemic control and reduces acute complications compared to multiple daily injection (MDI) therapy. This study aimed to assess the impact of insulin pump therapy on glycemic control and acute diabetes complications among patients with type 1 diabetes mellitus at King Fahad Armed Forces Hospital (KFAFH), Jeddah. We sought to compare patient outcomes before initiating insulin pump therapy (while on MDI insulin therapy), using Abbott FreeStyle Libre 2 continuous glucose monitoring (CGM), to their results after transitioning to insulin pump therapy for six months. The findings will contribute to understanding the effectiveness of this technology in a clinical setting and addressing gaps in its adoption.

Methods

A cross-sectional study was conducted among patients with type 1 diabetes mellitus aged seven years and older who attended the Diabetes and Endocrine Department at KFAFH, Jeddah. Data were collected using a structured survey.

Results

The study included 24 patients with type 1 diabetes mellitus, with a mean age of 22.79 ± 8.86 years and a mean BMI of 24.35 ± 4.96. The mean age at diagnosis was 12.25 ± 5.29 years. Most patients (n = 22, 91.7%) used the MiniMed™️ 780G system, which employs an advanced hybrid closed-loop (AHCL) algorithm. All participants underwent carbohydrate-counting sessions prior to the initiation of insulin pump therapy. After six months of insulin pump therapy, significant improvements (p<0.05) were observed in hemoglobin A1C (HbA1c) or glucose management indicator (GMI) levels, Percentage of time spent in target blood glucose range (TIR) per day, Percentage of time below target glucose range (TBR) per day, percentage of time very low below target glucose range per day, Frequency of hypoglycemia per week, diabetic ketoacidosis (DKA) admissions, and meal time flexibility. The findings will contribute to understanding the effectiveness of this technology in a clinical setting and addressing gaps in its adoption

Conclusions

Insulin pump therapy is associated with improved and sustained glycemic control in patients with type 1 diabetes mellitus. Achieving optimal blood glucose levels is critical for reducing the risk of diabetes-related complications and lowering mortality rates. These improvements significantly enhance the quality of life and reduce the economic burden associated with diabetes management.

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