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Comparative Study
. 2025 Aug;27(8):4239-4247.
doi: 10.1111/dom.16455. Epub 2025 May 19.

The impact of insulin pump therapy compared to multiple daily injections on complications and mortality in type 1 diabetes: A real-world retrospective cohort study

Sophie Haughton  1 , David Riley  2 , Simon Berry  1   3 , Muhammad Fahad Arshad  1   3 , Aikaterini Eleftheriadou  2 , Matthew Anson  2   4 , Yew Wen Yap  2 , Daniel J Cuthbertson  2 , Rayaz A Malik  5 , Shazli Azmi  4 , Uazman Alam  2 , Ahmed Iqbal  1   3
Affiliations
Comparative Study

The impact of insulin pump therapy compared to multiple daily injections on complications and mortality in type 1 diabetes: A real-world retrospective cohort study

Sophie Haughton et al. Diabetes Obes Metab. 2025 Aug.

Abstract

Aims: Clinical trials have demonstrated the benefits of insulin pump therapy compared with multiple daily injections (MDI) in type 1 diabetes. However, contemporaneous real-world data are limited. This study investigated the real-world impact of insulin pump therapy compared with MDI.

Materials and methods: A retrospective cohort study of adults with type 1 diabetes was performed on the TriNetX platform, a global network providing access to anonymised medical records. Outcomes analysed include HbA1c, diabetic ketoacidosis, macro- and microvascular complications and all-cause mortality. The five-year follow-up period, between January 2018 and March 2025, was divided into time windows for analysis.

Results: 95 122 individuals with type 1 diabetes were identified. After propensity score matching for confounders including age, ethnicity, gender, chronic kidney disease, retinopathy, HbA1c and microalbuminuria, 17 124 patients remained in both the pump and MDI cohorts. The absolute reduction in HbA1c was comparable at five years (-5.3 mmol/mol [-0.5%] in the pump group and -4.5 mmol/mol [-0.4%] in MDI). Overall mortality was lower (RR = 0.716 [95% CI 0.639-0.803], p < 0.001) in those on a pump compared to MDI. The occurrence of diabetic ketoacidosis was lower in the pump group compared to MDI (RR = 0.848 [95% CI 0.786-0.915], p < 0.001). The risk of diabetic retinopathy was increased in the pump group (RR = 1.331 [95% CI 1.247-1.420], p < 0.001).

Conclusions: Insulin pump therapy was associated with lower all-cause mortality and risk of diabetic ketoacidosis, but an increased risk of diabetic retinopathy compared with MDI. This result should be interpreted with caution due to potential differences in retinal screening frequency and subsequent bias.

Keywords: cohort study; diabetes complications; insulin pump therapy; real‐world evidence; type 1 diabetes.

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Conflict of interest statement

U.A. has received honoraria from Viatris, Grünenthal, Eli Lilly, Sanofi and Procter & Gamble for educational meetings, investigator‐led funding from Proctor & Gamble and received sponsorship to attend educational meetings from Daiichi Sankyo and Sanofi. A.I. has received research support from Abbott and Dexcom Inc. plus speaker fees from AstraZeneca, Boehringer Ingelheim, and Eli Lilly. S. B. has received research support from Dexcom and Tandem Diabetes Care. R.A.M. has received honoraria from Novo Nordisk, Viatris, Eli Lilly, Sanofi and Procter & Gamble for educational meetings and has received investigator‐led funding from Novo Nordisk and Procter & Gamble. D.J.C. has received investigator‐initiated grants from AstraZeneca and Novo Nordisk, and support for education from Perspec‐tum. M.A. receives a fellowship from the Novo Nordisk UK research foundation and JDRF. Y.W.Y., D.R., S.H., A.E. and M.F.A. have no competing interests or disclosures.

Figures

FIGURE 1
FIGURE 1
Outcomes from time window 1–2 years. N, total number in cohort; n, number in group with the outcome.
FIGURE 2
FIGURE 2
Outcomes from time window 2–5 years. N, total number in cohort; n, number in group with the outcome.
FIGURE 3
FIGURE 3
Mean HbA1c at the end of each time window with insulin pump (circles) and MDI (squares) and table of number (n) in the group with a HbA1c outcome.
See this image and copyright information in PMC

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