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Comparative Study
. 2019 Dec 29;9(12):e033059.
doi: 10.1136/bmjopen-2019-033059.

HbA1c variability in adults with type 1 diabetes on continuous subcutaneous insulin infusion (CSII) therapy compared to multiple daily injection (MDI) treatment

Emma S Scott  1   2 , Rachel T McGrath  2   3 , Andrzej S Januszewski  1   4 , Daniel Calandro  1 , Anandwardhan A Hardikar  1 , David N O'Neal  5   6 , Gregory Fulcher  2   3 , Alicia J Jenkins  7   5
Affiliations
Comparative Study

HbA1c variability in adults with type 1 diabetes on continuous subcutaneous insulin infusion (CSII) therapy compared to multiple daily injection (MDI) treatment

Emma S Scott et al. BMJ Open. .

Abstract

Objective: To determine if continuous subcutaneous insulin infusion (CSII) therapy is associated with lower glycated haemoglobin (HbA1c) variability (long-term glycaemic variability; GV) relative to multiple daily injection (MDI) treatment in adults with type 1 diabetes mellitus (T1DM).

Design: Retrospective audit.

Setting and participants: Clinic records from 506 adults with T1DM from two tertiary Australian hospitals.

Outcome measures: Long-term GV was assessed by HbA1c SD and coefficient of variation (CV) in adults on established MDI or CSII therapy, and in a subset changing from MDI to CSII.

Results: Adults (n=506, (164 CSII), 50% women, mean±SD age 38.0±15.3 years, 17.0±13.7 years diabetes, mean HbA1c 7.8%±1.2% (62±13 mmol/mol) on CSII, 8.0%±1.5% (64±16 mmol/mol) on MDI) were followed for 4.1±3.6 years. CSII use was associated with lower GV (HbA1c SD: CSII vs MDI 0.5%±0.41% (6±6 mmol/mol) vs 0.7%±0.7% (9±8 mmol/mol)) and CV: CSII vs MDI 6.7%±4.6% (10±10 mmol/mol) vs 9.3%±7.3% (14±13 mmol/mol), both p<0.001. Fifty-six adults (73% female, age 36±13 years, 16±13 years diabetes, HbA1c 7.8%±0.8% (62±9 mmol/mol)) transitioned from MDI to CSII. Mean HbA1c fell by 0.4%. GV from 1 year post-CSII commencement decreased significantly, HbA1c SD pre-CSII versus post-CSII 0.7%±0.5% (8±5 mmol/mol) vs 0.4%±0.4% (5±4 mmol/mol); p<0.001, and HbA1c CV 9.2%±5.5% (13±8 mmol/mol) vs 6.1%±3.9% (9±5 mmol/mol); p<0.001.

Conclusions: In clinical practice with T1DM adults relative to MDI, CSII therapy is associated with lower HbA1c GV.

Keywords: diabetes & endocrinology; general diabetes; paediatric endocrinology.

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Conflict of interest statement

Competing interests: Funding (scholarships for ES) were provided by NHMRC (Australia), JDRF Australia, the University of Sydney and the Royal Australasian College of Physicians Vincent Fairfax Award. AJJ was supported by a NHMRC Practitioner Fellowship and funding from the NHMRC Clinical Trials Centre and is a Sydney Medical Foundation School Fellow. AAH is supported by a career development award from the JDRF Australia T1D Clinical Research Network.

Figures

Figure 1
Figure 1
Long-term glycaemic (HbA1c) variability in 164 CSII and 342 MDI participants. SD of HbA1c over follow-up (0.5%±0.4% (6±6) mmol/mol CSII, 0.7%±0.7% (9±8) mmol/mol MDI) (A) and coefficient of variation of HbA1c over follow-up (6.7%±4.6% (10±10) mmol/mol CSII, 9.3%±7.3% (14±13) mmol/mol MDI) (B). Black bars=CSII; white bars=MDI. Graphed values are mean±SEM p<0.001. CSII,continuous subcutaneous insulin infusion; HbA1c, glycated haemoglobin;MDI, multiple dailyinjection.
Figure 2
Figure 2
Long-term glycaemic variability by predefined age groups. Adults aged 18 to 26 years (n=54 on CSII, n=69 on MDI) SD of HbA1c (0.6%±0.4% (7±8) mmol/mol CSII, 0.9%±0.6% (11±7) mmol/mol MDI; p=0.001) (A), coefficient of variation HbA1c over follow-up (7.3%±5.5% (12±16) mmol/mol CSII, 10.5%±5.9% (16±12) mmol/mol MDI; p=0.002) (B), adults aged ≥26 years (110 CSII, 273 MDI) SD of HbA1c (0.5%±0.4% (5±4) mmol/mol CSII, 0.7%±0.7% (9±8) mmol/mol MDI; p<0.001) (C), coefficient of variation over follow-up (6.3%±4.2% (9±5) mmol/mol CSII, 8.9%±7.6% (14±13) mmol/mol MDI; p<0.001) (D). Black bars=CSII; white bars=MDI. Graphed values are mean±SEM. CSII,continuous subcutaneous insulin infusion; HbA1c, glycated haemoglobin;MDI, multiple dailyinjection.
Figure 3
Figure 3
Long-term glycaemic variability in individuals changing from MDI to CSII therapy. Fifty-six adults changed from MDI to CSII therapy over the study. Mean HbA1c over follow-up (p<0.001) (A), SD of HbA1c (p<0.001) (B) and coefficient of variation of HbA1c over follow-up (p=0.004) (C). Black circles=MDI; white squares=CSII. Graphed values are mean pre-therapy and post-therapy change. CSII,continuous subcutaneous insulin infusion; HbA1c, glycated haemoglobin;MDI, multiple dailyinjection.
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