title: Risk factors for discontinuation of insulin pump therapy in pediatric and young adult patients.
abstract: BACKGROUND
  Previous studies have shown that only a small number of pediatric and young adult patients discontinue pump therapy, but risk factors for discontinuation are unclear.
  
  
  OBJECTIVE
  To identify characteristics of pediatric and young adult patients with pump therapy which are associated with discontinuation of treatment.
  
  
  METHODS
  Retrospective cohort study using a representative nationwide database (LRx; IMS Health) in Germany covering >80% of all prescriptions to members of statutory health insurances in 2008-2011. All patients (age group <25 years) with new prescriptions of insulin pumps were identified (2009-2010) and were followed for 12 months.
  
  
  RESULTS
  Overall, 2452 new pump users were identified, of whom 177 (7.2%) switched to other forms of insulin therapy within 12 months. In multivariate logistic regression, younger age (<6 years; reference 18 to <25 years: Odds ratio, OR, 95% CI: 0.36; 0.17-0.74) and use of teflon needles (reference steel needles: OR, 95% CI: 0.59; 0.41-0.83) were related to a lower odds of pump discontinuation. A non-significant trend was found for male sex (OR, 95% CI: 0.75; 0.52-1.08). Prescriptions of thyroid therapeutics (ATC H03A: OR, 95% CI: 1.79; 1.23-2.61) and antiepileptics (N03: OR, 95% CI: 3.14; 1.49-6.59) were significantly associated with discontinuation of pump therapy.
  
  
  CONCLUSIONS
  About 93% of pediatric and young adult patients maintained insulin pump therapy within 12 months. Age <6 years, male sex and teflon needle use were associated with a lower risk of discontinuation. Thyroid therapy (indicating autoimmunity) and antiepileptic drug prescriptions were associated with a higher likelihood for discontinuation of insulin pump treatment.
authors.affiliation: IMS HEALTH, D-60598 Frankfurt/Main, Germany. Electronic address: kkostev@de.imshealth.com.
authors.forename: Karel
authors.initials: K
authors.lastname: Kostev
authors.affiliation: IMS HEALTH, D-60598 Frankfurt/Main, Germany.
authors.forename: Timo
authors.initials: T
authors.lastname: Rockel
authors.affiliation: Institute for Biometrics and Epidemiology, German Diabetes Center, D-40225 Duesseldorf, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Rosenbauer
authors.affiliation: Institute for Biometrics and Epidemiology, German Diabetes Center, D-40225 Duesseldorf, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Rathmann
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000927:Anticonvulsants / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis / Q000188:drug therapy*; D004334:Drug Administration Schedule; D004867:Equipment Design; D005260:Female; D005858:Germany; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009339:Needles; D016017:Odds Ratio; D019338:Polypharmacy; D011138:Polytetrafluoroethylene; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D007004:Hypoglycemic Agents; D007328:Insulin; D011138:Polytetrafluoroethylene
keywords: Childhood diabetes; Discontinuation of insulin pump treatment; Insulin pump therapy; Type 1 diabetes