Continuous subcutaneous insulin infusion (CSII) therapy at Derby Teaching Hospitals: sustained benefits in glucose control

• Published in: Diabetic medicine Vol. 34; no. 8; pp. 1154 - 1157
• Main Authors: Anyanwagu, U., Olaoye, H., Jennings, P., Ashton‐Cleary, S., Sugunendran, S., Hughes, D., Idris, I., Wilmot, E. G.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-08-2017
• Subjects: Adult; Cohort Studies; Cross-Sectional Studies; Diabetes; Diabetes Mellitus, Type 1 - blood; Diabetes Mellitus, Type 1 - drug therapy; England; Female; Follow-Up Studies; Glycated Hemoglobin A - analysis; Hospitals; Hospitals, Teaching; Humans; Hyperglycemia - prevention & control; Hypoglycemia; Hypoglycemia - chemically induced; Hypoglycemia - prevention & control; Hypoglycemic Agents - administration & dosage; Hypoglycemic Agents - adverse effects; Hypoglycemic Agents - therapeutic use; Insulin; Insulin - administration & dosage; Insulin - adverse effects; Insulin - therapeutic use; Insulin Infusion Systems - adverse effects; Male; Middle Aged; Patient Satisfaction; Quality of Life; Self Report; Teaching hospitals; United Kingdom > UK
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/dme.13367

Aim
In the short term, continuous subcutaneous insulin infusion (CSII) has been associated with improved glycaemic control, reduced hypoglycaemia and improved quality of life (QOL). However, limited data are available on its long‐term benefits, particularly in the UK. We aimed to assess the impact of CSII on longer term outcomes.
Method
Patient‐level data were obtained for CSII users at Derby Teaching Hospitals, UK. Patient confidence and satisfaction questionnaires using the Likert scale were used to assess confidence in self‐management. Comparative statistics were conducted using Pearson's chi‐square and Student's t‐tests.
Results
Some 258 CSII users were identified (60.1% female, mean age 43.9 ± 13.4 years). Overall, there was significant decrease in HbA1c from 78 mmol/mol (9.3 ± 2.0%) at baseline, to 69 mmol/mol (8.5 ± 1.3%) at 6 months [mean difference (md): –0.64; 95% confidence interval (95% CI): –0.91 to –0.37; P < 0.0001]; which was sustained at 6 years of follow‐up (HbA1c: 66 mmol/mol, 8.2 ± 1.3%; md: –1.07%; 95% CI: –1.45 to –0.69; P < 0.0001). One hundred and twenty‐one patients (47%) responded to the survey, of whom 95 (78.5%) reported a reduction in the frequency of hypoglycaemia; 102 (84.3%) were satisfied with the quality of care received in the insulin pump service.
Conclusion
CSII therapy led to a sustained long‐term improvement in glycaemic control in addition to a reduction in self‐reported hypoglycaemia.
What's new?
The short‐term benefits of continuous subcutaneous insulin infusion (CSII) are well established, but there is very limited UK data on the long‐term benefits.
CSII use in this study was associated with significant and sustained improvement in glycaemic control over 6 years.
A user evaluation identified a self‐reported reduction in hypoglycaemia with CSII use.
These real‐world data support the current UK NICE recommendations for CSII use.