title: Availability of insulin pump therapy in clinical practice.
abstract: OBJECTIVE
  To examine the availability of insulin pump therapy in patients with Type 1 diabetes.
  
  
  METHODS
  Patients using insulin pumps among a cohort of 7224 patients with Type 1 diabetes were studied.
  
  
  RESULTS
  In logistic regression, used to evaluate variables not changing over time among the total cohort, use of insulin pumps varied by outpatient clinic (P<0.001) and sex (P<0.001). Cox regression analysis in 5854 patients with detailed patient data prior to use of an insulin pump showed higher HbA(1c) (P<0.0001), lower creatinine (P=0.002), high and low insulin doses (P<0.0001), younger age (P<0.0001) and female sex (P<0.0001) to be associated with use of an insulin pump. Women were 1.5-fold more likely to start using an insulin pump (hazard ratio 1.52, 95% confidence interval 1.29-1.79) and patients in the 20- to 30-years age range were more than twice as likely to begin use of an insulin pump than patients aged 40-50 years (hazard ratio 8.63, 95% confidence interval 5.91-12.59 and hazard ratio 3.98, 95% confidence interval 2.80-5.64, respectively). A 10-μmol/l higher level of creatinine was associated with a hazard ratio of 0.56 (95% confidence interval 0.39-0.81) of starting use of an insulin pump.
  
  
  CONCLUSIONS
  At 10 hospital outpatient clinics in Sweden, use of insulin pumps therapy varied by clinic. A higher proportion of women began using insulin pumps. Younger patients and patients with fewer complications were also more likely to start using an insulin pump. Further research is needed to confirm these findings in other geographical regions and to understand whether the availability of insulin pumps today is optimized.
authors: Diabetes Section of Medicine, SÄS-Hospital Organization, Skene, Uddevalla, Sweden.
authors: B-M
authors: BM
authors: Carlsson
authors: P Nord
authors: PN
authors: Andersson
authors: J
authors: J
authors: Alnervik
authors: J
authors: J
authors: Carstensen
authors: M
authors: M
authors: Lind
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems / Q000600:supply & distribution*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D013548:Sweden; D055815:Young Adult
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin