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HbA1c variability in adults with type 1 diabetes on continuous subcutaneous insulin infusion (CSII) therapy compared

Emma S Scott1,2, Rachel T McGrath2,3, Andrzej S Januszewski1,4

  • 1NHMRC Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia.

BMJ Open
|January 1, 2020
PubMed

Insights

Continuous subcutaneous insulin infusion (CSII) therapy significantly lowers glycated haemoglobin (HbA1c) variability in adults with type 1 diabetes mellitus (T1DM) compared to multiple daily injections (MDI). This improvement is observed both in established users and those transitioning from MDI to CSII.

Area of Science:

  • Endocrinology and Metabolism
  • Diabetes Research
  • Clinical Therapeutics

Background:

  • Type 1 diabetes mellitus (T1DM) management requires precise glycemic control to mitigate long-term complications.
  • Glycemic variability (GV), indicated by fluctuations in glycated haemoglobin (HbA1c), is a critical factor influencing diabetes outcomes.
  • Continuous subcutaneous insulin infusion (CSII) and multiple daily injections (MDI) are primary treatment modalities for T1DM.

Purpose of the Study:

  • To compare long-term glycemic variability (GV) between continuous subcutaneous insulin infusion (CSII) and multiple daily injection (MDI) therapies in adults with type 1 diabetes mellitus (T1DM).
  • To assess the impact of transitioning from MDI to CSII on glycemic variability.

Main Methods:

  • Retrospective audit of clinic records from 506 adults with T1DM at two Australian tertiary hospitals.
  • Assessment of long-term GV using HbA1c standard deviation (SD) and coefficient of variation (CV).
  • Analysis included patients on established MDI or CSII, and a subset who transitioned from MDI to CSII.

Main Results:

  • CSII therapy was associated with significantly lower GV compared to MDI therapy (HbA1c SD: 0.5% vs 0.7%, p<0.001; HbA1c CV: 6.7% vs 9.3%, p<0.001).
  • In a subset of 56 adults transitioning from MDI to CSII, mean HbA1c decreased by 0.4%.
  • Glycemic variability significantly decreased post-transition to CSII (HbA1c SD: 0.7% to 0.4%, p<0.001; HbA1c CV: 9.2% to 6.1%, p<0.001).

Conclusions:

  • Continuous subcutaneous insulin infusion (CSII) therapy is associated with reduced glycated haemoglobin (HbA1c) variability in adults with type 1 diabetes mellitus (T1DM) when compared to multiple daily injections (MDI).
  • Transitioning from MDI to CSII leads to a significant reduction in glycemic variability.
  • CSII represents a valuable therapeutic option for improving glycemic control and reducing variability in T1DM management.
Abstract

Keywords:
diabetes & endocrinologygeneral diabetespaediatric endocrinology

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