Background: Long-term outcomes in diabetic patients are associated with good glycaemic control. In the UK, the National Institute of Clinical Excellence recommends that insulin pump therapy is used for patients when multiple injections are impractical or inappropriate (Guideline 151, 2008). However, insulin pumps are very expensive and some previous studies do not suggest a significant improvement in glycaemic control compared with multiple injections. The aim of our study was to examine if a cohort of patients had improved glycaemic control after commencing insulin pump therapy.
Methods: All paediatric patients on continuous insulin pumps at our centre were identified in November 2017. Demographic data was collected from each patient. Glycaemic control (HbA1c) was assessed at 3, 6 and 12 months prior to commencing the pump and at 3, 6, 12, 18 and 24 months after commencing the pump. Mean and median HbA1c were calculated and changes in HbA1c were analysed by gender and age when commencing the pump. Appropriate t-test was used to assess for statistically significant differences.
Results: Sixty-six patients fit our inclusion criteria, with data available for forty-seven (71%) patients. Mean HbA1c at 12 months prior to commencing insulin pump was 59 mmol/l, mean HbA1c at 3 months prior to the pump was 58 mmol/l. Mean HbA1c at 6, 12 and 18 months following starting the pump was 60 mmol/l at each time point. There were no significant differences in HbA1c from 12 months prior to pump therapy to 18 months post therapy. There were no statistical differences for gender (p value 0.14 at 12 months after commencing pump) or age at commencing pump therapy (p value 0.83 12 months after commencing pump). Patients from a more deprived area had significantly worse glycaemic control prior to commencing pump therapy, but there was no significant difference with those from less deprived areas once pump therapy had been commenced.
Discussion: Our results showed that there was no significant improvement in glycaemic control with pump therapy. Gender and age of patient had no effect. Those from a more deprived area had worse glycaemic control prior to commencing pump therapy but this was not different from patients from more affluent areas after pump therapy had commenced. This indicates that perhaps these patients from more deprived areas need input prior to pump therapy, and all patients need more input and education after commencing on the pump.
19 - 21 Sep 2019
European Society for Paediatric Endocrinology