| Autor: |
Moreno-Fernandez J; Department of Endocrinology and Nutrition, Ciudad Real General University Hospital, Ciudad Real, Spain., Chico A; Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain., Martínez-Brocca MA; Department of Endocrinology and Nutrition, University Hospital Virgen Macarena, Sevilla, Spain., Beato-Víbora PI; Department of Endocrinology and Nutrition, Badajoz University Hospital, Badajoz, Spain., Vidal M; Department of Endocrinology and Nutrition, Barcelona Clinic Hospital, Barcelona, Spain., Piedra M; Department of Endocrinology and Nutrition, Marqués de Valdecilla University Hospital, Santander, Spain., Quirós C; Department of Endocrinology and Nutrition, Terrassa Hospital, Terrassa, Barcelona, Spain., Muñoz-Rodríguez JR; Translational Research Unit, Ciudad Real General University Hospital, Ciudad Real, Spain. |
| Abstrakt: |
Aim: To analyze the clinical effect of continuous subcutaneous insulin infusion (CSII) in type 1 diabetes mellitus (T1D) patients in the Spanish real-world scenario. Methods: All T1D patients on CSII registered in the SPAnish Insulin Pump (SPAIP) registry were included. The primary efficacy outcome was change in HbA1c during follow-up. Secondary efficacy outcomes included: insulin pump indications, diabetes complication rates, insulin and pump use, and continuous glucose monitoring (CGM) glycometrics. Patient data were typed through the web-based SPAIP registry. Results: Data from 2979 T1D patients treated with CSII were analyzed. The median age was 44 years (interquartile range [IQR] 34-52 years), and T1D duration was 27 years (IQR 18-35 years). The median duration of CSII therapy was 6 years (IQR 3-10 years). The main indications for treatment were suboptimal glycemic control (33.8%), hypoglycemia (22.1%), and increased glycemic variability (18.8%). Glycated hemoglobin decreased by 6 mmol/mol (95% CI, -5 to -6 mmol/mol, P < 0.001) [-0.5%, 95% CI, -0.4 to -0.5, P < 0.001] during the follow-up. The percentage of patients with severe hypoglycemia decreased from 14.9% to 0.9% ( P < 0.001). We observed an inverse correlation between final HbA1c levels and CGM adherence ( R = -0.24, P < 0.001) or percentage of time with active hybrid closed-loop functions ( R = -0.25, P < 0.001). Conclusions: CSII treatment was associated with a sustained improvement in glycemic control in the Spanish population. This benefit was greater among patients with higher CGM or active hybrid closed-loop functions adherence. The protocol was publicly registered at ClinicalTrials.gov (NCT04761094). |
