Success of Insulin Pump Therapy Predicted by Pre-Pump Glycemic Control in T1D

Hemoglobin A1c levels before the initiation of insulin pump therapy predicted the extent to which insulin pump therapy improved glycemic control in children with type 1 diabetes.

Hemoglobin A1c (HbA1c) levels before initiating the use of an insulin pump predicted the extent to which insulin pump therapy improved glycemic control in children with type 1 diabetes (T1D), according to study results published in Pediatric Diabetes.

To examine the effects of insulin pump therapy on HbA1c in children with T1D and the specific role pre-pump HbA1c plays in the results, researchers retrospectively followed 125 individuals who started insulin pump therapy at a tertiary Canadian pediatric hospital (median age at initiation of therapy, 11.0 years).

The researchers utilized a Generalized Estimating Equation method to estimate pre-pump mean HbA1c and examine mean changes before and after pump initiation in each participant. Patients were classified as having good, moderate, or poor metabolic control (mean pre-pump HbA1c level <7.5%, 7.5-9.0%, and >9.0%, respectively).

Of the total population, 37 patients had good pre-pump metabolic control, 72 moderate metabolic control, and 16 poor metabolic control. The poor control group had a lower median age at diagnosis of T1D and an increased length of time to pump initiation than the moderate and good control groups.

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Adjusting for possible confounders, the researchers discovered that HbA1c levels decreased by an average of 0.48% (P <.0001) after insulin pump therapy. The adjusted mean HbA1c levels were reduced by 0.14% in the group with good metabolic control (P =.188), 0.54% in the group with moderate metabolic control (P <.0001), and 1.08% in the group with poor metabolic control (P =.0006).

Several limitations were noted for this study, including its retrospective design, relatively small sample size, and short, 18-month follow-up period.

“Our study demonstrates for the first time in a large cohort of young children the varying degree of improvement in HbA1c after [insulin pump therapy] initiation based on the children’s pre-pump HbA1c after controlling for other potentially confounding variables,” the researchers said. “These results highlight that eligibility and consideration for [insulin pump therapy] should be expanded to routinely include children with high HbA1c.”

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Botros S, Islam N, Hursh B. Insulin pump therapy, pre-pump HbA1c and metabolic improvement in children with type 1 diabetes at a tertiary Canadian children’s hospital [published online February 18, 2019]. Pediatr Diabetes. doi:10.1111/pedi.12834