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. 2016 Apr 6;11(4):e0153033.
doi: 10.1371/journal.pone.0153033. eCollection 2016.

Insulin Pump Therapy Is Associated with Lower Rates of Retinopathy and Peripheral Nerve Abnormality

Bedowra Zabeen  1   2 , Maria E Craig  1   3   4 , Sohaib A Virk  1   3 , Alison Pryke  1 , Albert K F Chan  1 , Yoon Hi Cho  1   4 , Paul Z Benitez-Aguirre  1   4 , Stephen Hing  5 , Kim C Donaghue  1   4
Affiliations

Insulin Pump Therapy Is Associated with Lower Rates of Retinopathy and Peripheral Nerve Abnormality

Bedowra Zabeen et al. PLoS One. .

Abstract

Objective: To compare rates of microvascular complications in adolescents with type 1 diabetes treated with continuous subcutaneous insulin infusion (CSII) versus multiple daily injections (MDI).

Research design and methods: Prospective cohort of 989 patients (aged 12-20 years; diabetes duration >5 years) treated with CSII or MDI for >12 months. Microvascular complications were assessed from 2000-14: early retinopathy (seven-field fundal photography), peripheral nerve function (thermal and vibration threshold testing), autonomic nerve abnormality (heart rate variability analysis of electrocardiogram recordings) and albuminuria (albumin creatinine ratio/timed overnight albumin excretion). Generalized estimating equations (GEE) were used to examine the relationship between treatment and complications rates, adjusting for socio-economic status (SES) and known risk factors including HbA1c and diabetes duration.

Results: Comparing CSII with MDI: HbA1C was 8.6% [70mmol/mol] vs. 8.7% [72 mmol/mol]) (p = 0.7), retinopathy 17% vs. 22% (p = 0.06); microalbuminuria 1% vs. 4% (p = 0.07), peripheral nerve abnormality 27% vs. 33% (p = 0.108) and autonomic nerve abnormality 24% vs. 28% (p = 0.401). In multivariable GEE, CSII use was associated with lower rates of retinopathy (OR 0.66, 95% CI 0.45-0.95, p = 0.029) and peripheral nerve abnormality (OR 0.63, 95% CI 0.42-0.95, p = 0.026), but not albuminuria (OR 0.46, 95% CI 0.10-2.17, p = 0.33). SES was not associated with any of the complication outcomes.

Conclusions: In adolescents, CSII use is associated with lower rates of retinopathy and peripheral nerve abnormality, suggesting an apparent benefit of CSII over MDI independent of glycemic control or SES.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Rate of microvascular complications according to insulin delivery: CSII vs MDI.
Fig 2
Fig 2. Effect of pump therapy compared to multiple daily injections for microvascular complications.
Multivariable analysis (GEE), after inclusion of HbA1c and other confounders: significant reduction for retinopathy after allowing for HbA1c, age and duration; and significant reduction for peripheral nerve abnormalities after allowing for HbA1c, male gender and height SDS.
See this image and copyright information in PMC

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