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. 2019 Mar 21;8(3):394.
doi: 10.3390/jcm8030394.

Long-Term Effects of Initiating Continuous Subcutaneous Insulin Infusion (CSII) and Continuous Glucose Monitoring (CGM) in People with Type 1 Diabetes and Unsatisfactory Diabetes Control

Jon-Duri Senn  1 , Stefan Fischli  2 , Lea Slahor  3 , Susanne Schelbert  4 , Christoph Henzen  5
Affiliations

Long-Term Effects of Initiating Continuous Subcutaneous Insulin Infusion (CSII) and Continuous Glucose Monitoring (CGM) in People with Type 1 Diabetes and Unsatisfactory Diabetes Control

Jon-Duri Senn et al. J Clin Med. .

Abstract

Background: We aimed to assess the long-term effects of the introduction of continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) in people with type 1 diabetes (T1D).

Methods: A prospective single-centre cohort study including participants with T1D and HbA1c > 7.5%. After completing a course in flexible intensified insulin treatment (FIT), participants were offered treatment change to CSII/CGM. FIT participants with HbA1c ≤ 7.5% who remained on multiple daily injections (MDI) and without CGM were monitored as a separate cohort to compare the cumulative incidence of diabetic complications.

Results: The study cohort included 41 participants with T1D (21 male/20 female). The mean age (±SD) at inclusion was 24.2 ± 10.9 years, the mean follow-up was 8.9 ± 2.8 years, and the mean diabetes duration at the end of the study was 15.9 ± 10.1 years. The mean HbA1c level before the introduction of CSII was 8.8 ± 1.3% (73 ± 8 mmol/mol), and decreased significantly thereafter to 8.0 ± 1.1% (63 ± 7 mmol/mol) (p = 0.0001), and further to 7.6 ± 1.1% (59 ± 11 mmol/mol) after the initiation of CGM (p = 0.051). In the MDI group the HbA1c levels did not change significantly during a mean follow-up of 6.8 ± 3.2 years. The frequency of severe hypoglycaemia after the introduction of CSII/CGM declined significantly (from 9.7 to 2.2 per 100 patient-years, p = 0.03), and the cumulative incidence of newly diagnosed diabetic microvascular complications were comparable between the study group and the observational cohort.

Conclusion: In people with T1D and unsatisfactory diabetes control the introduction of CSII and CGM results in a substantial and long-term improvement.

Keywords: Type 1 diabetes; continuous glucose monitoring; continuous subcutaneous insulin infusion; functional insulin therapy; insulin pump.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram showing the selection of the study population. CSII: Continuous Subcutaneous Insulin Infusion; CGMS: Continuous Glucose Monitoring System; MDI: Multiple Daily Injections; FIT: Functional Insulin Therapy; T1D, type 1 diabetes.
Figure 2
Figure 2
Course of the HbA1c levels in participants after treatment change to CSII and introduction of CGM (n = 41). * p = 0.003; ** p = 0.23; *** p = 0.051 (Box plots show the median and the interquartile range, and whiskers are minimum/maximum).
Figure 3
Figure 3
Individual course of the HbA1c levels over the entire study duration (n = 41).
Figure 4
Figure 4
Total daily insulin dose before and after the introduction of CSII and CGM (n = 41) (p = 0.62).
Figure 5
Figure 5
Basal insulin dose before and after the introduction of CSII and CGM (n = 41) (p = 0.41).
Figure 6
Figure 6
Bolus insulin dose before and after the introduction of CSII and CGM (n = 41) (* p = 0.033).
See this image and copyright information in PMC

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