Resultados a medio-largo plazo de pacientes con diabetes tipo 1 remitidos a una consulta monográfica de bombas de insulina

Objective

To analyse the first 69 type 1 diabetes patients referred to a specialist team between 2005 and 2012 in order to evaluate the indication for continuous subcutaneous insulin infusion (CSII).

Methods

Retrospective, observational, single centre study conducted on 69 adult patients evaluated for CSII. An analysis was made on patients who did not initiate CSII (n = 18) and patients who were treated with CSII (n = 51). Variables included: age, gender, duration of disease, indication for CSII, HbA1c, frequency of severe hypoglycaemia events, episodes of diabetic ketoacidosis, and pump discontinuation.

Results

The main reason for not initiating CSII was patient refusal (49%), followed by improving of glycaemic control (33%) after optimising with multiple daily injections (MDI) therapy. The most common CSII indications were: suboptimal glycaemic control (49%), and suboptimal glycaemic control with frequent non-severe hypoglycaemia (27.5%). Baseline HbA1c was 8.6 ± 1.5%, and there was a significant and sustained decrease of 1% over a 5 year period (P < .001), with this reduction being greater in patients with HbA1c > 8%. The use of CSII was stopped by 5 patients (10%) after 1 to 6 years.

Conclusion

In our clinical practice one in four patients evaluated for CSII did not initiate it. The switch from MDI to CSII was associated with a 1% reduction in HbA1c over 5 years, being greater in patients with poor glycaemic control.