Factors associated with withdrawal from insulin pump therapy: A large-population-based study

Area of Science:

• Endocrinology
• Metabolic Disorders
• Medical Technology

Background:

• Increasing use of insulin pump (IP) therapy for diabetes management.
• Limited data on factors influencing IP therapy withdrawal.

Purpose of the Study:

• Identify factors associated with insulin pump therapy withdrawal in diabetic patients.
• Analyze patient characteristics predicting nonadherence to IP therapy.

Main Methods:

• Cross-sectional study utilizing data from an Israeli health maintenance organization.
• Identified patients (≥21 years) with type 1 (T1DM) or type 2 (T2DM) diabetes on IP therapy for 7 years.
• Defined withdrawal as no IP maintenance supply purchase for ≥6 consecutive months.

Main Results:

• Longer diabetes duration (>5 years), nonadherence to dietician follow-up, and poor pre-IP glycemic control were significant predictors of withdrawal in both T1DM and T2DM patients.
• Comorbid neuro-psychiatric disorders, including depression, ADHD, and dementia, were also associated with increased IP withdrawal rates.
• Specific odds ratios (ORs) highlight the strength of these associations, with P < .05 for all significant factors.

Conclusions:

• Real-world data indicate smoking, obesity, poor glycemic control, and neuro-psychiatric comorbidities are associated with high insulin pump therapy withdrawal rates.
• Healthcare providers should recognize patient characteristics predicting nonadherence.
• Intensified patient follow-up is recommended when implementing insulin pump therapy.