Pediatric Diabetes

 Long-term Study of Tubeless Insulin Pump Therapy Compared to Multiple Daily Injections in Youth with Type 1 Diabetes: Data from the German/Austrian DPV-Registry
Objective To examine glycemic control in youth with type 1 diabetes (T1D) who switched from multiple daily injections (MDI) to a tubeless insulin pump (Omnipod® Insulin Management System, Insulet Corp., Billerica, MA) compared to patients who continued MDI therapy over a 3-year time period. Research Design and Methods This retrospective analysis of the German/Austrian Diabetes Patienten Verlaufsdokumentation (DPV) registry included data from 263 centers and 2529 patients <20 years (n=660 tubeless insulin pump; n=1869 MDI) who initiated treatment on a tubeless insulin pump as of January 1, 2013 and had 1 year of data pre-switch from MDI and 3 years of data post-switch to a tubeless pump. Outcomes included the change in HbA1c, insulin dose and BMI standard deviation score (SDS). Results Youth with T1D who switched from MDI therapy to a tubeless insulin pump showed better glycemic control at 1 year compared to patients who continued MDI treatment, adjusted mean±SE: 7.5%±0.03 (58 mmol/mol) vs. 7.7%±0.02 (61 mmol/mol); p<0.001, with no between group difference at 2- and 3-years. Total daily insulin dose was lower (p<0.001) in the tubeless insulin pump group, 0.80±0.01, 0.81±0.01 and 0.85±0.01 U/kg vs. the MDI group 0.89±0.01, 0.94±0.01 and 0.97±0.01 U/kg, at 1-, 2- and 3-years, respectively (all p<0.001). BMI (SDS) increased in both groups and was not different over time. Conclusions Treatment with a tubeless insulin pump in youth with T1D was associated with improvements in glycemic control compared to MDI after 1 year and appears to be an effective alternative to MDI.