Endocrine Abstracts

Introduction: The use of Continuous Subcutaneous Insulin Infusion (CSII) is expected to improve glycemic control and to reduce hypoglycemia events. However, long-term beneficial results in glucose control are not always observed. We evaluated long-time glucose control and severe hypoglycemias in type 1 diabetic patients using CSII, without continuous glucose monitoring.

Patients and methods: This was a retrospective study of adult type 1 diabetic patients using CSII, assisted at the endocrinology outpatient department of a tertiary hospital. Mean HbA1c was evaluated before CSII, and each year thereafter. Severe hypoglycemias were registered in the year before CSII and the last two years of follow-up.

Results: Ninety patients were studied (66% female). They used CSII since 34±10 years old and had type 1 diabetes since 18±11 years before. Follow-up with CSII was 6.3±2.6 years. HbA1c at baseline and during follow-up with CSII was as follows: Overall, HbA1c significantly decreased (P<0.001) in the first year with CSII and remained lower than baseline during the first six years of follow-up (P<0.05). However, higher pre-CSII HbA1c was related to a greater decrease in HbA1c until the last year of follow-up (r=+0.582, P<0.001, n=56). In fact, in patients with baseline HbA1c≥8%, this parameter significantly decreased until the sixth year (P<0.03), while for patients with baseline HbA1c<8%, it decreased only during the first year of follow-up (P=0.009). Severe hypoglycemias (78% in patients with baseline HbA1c<8%) significantly reduced after CSII (P<0.05).

Discussion: The best glycemic control was observed during the first year using CSII, eventually in relation to patients’ motivation towards the introduction of a new therapeutic approach. Patients with worse baseline glycemic control were the ones who showed larger improvements with CSII. In fact, CSII was effective in long-term glycemic improvement in patients with baseline HBA1c≥8%. On the other hand, CSII also reduced severe hypoglycemic events, which affected mostly patients with baseline HbA1c<8%.