title: Variations in the quality and sustainability of long-term glycaemic control with continuous subcutaneous insulin infusion.
abstract: OBJECTIVE
  To investigate the pattern of changes in HbA1c in people with Type 1 diabetes managed by long-term Continuous subcutaneous insulin infusion.
  
  
  METHODS
  We studied HbA1c changes using computerized clinic records in 35 adult people with Type 1 diabetes and an elevated HbA1c (≥ 64 mmol/mol, 8.0%) on multiple daily insulin injections, who were then switched to continuous subcutaneous insulin infusion for at least 5 years.
  
  
  RESULTS
  We identified three subgroups with similar baseline HbA1c but different long-term responses to pump therapy: group A--those with improvement followed by deterioration (57%); group B--those with improvement that was sustained throughout the 5 years (31%); and group C-those where HbA1c did not change significantly from baseline (12%). The patients in group C had a higher BMI: 31.0 ± 5.2 vs. 25.9 ± 3.3 vs. 25.2 ± 3.1 kg/m² (group C vs. group A and group B; P = 0.02).
  
  
  CONCLUSIONS
  Improved glycaemic control with continuous subcutaneous insulin infusion was maintained over 5 years by 88% of people with Type 1 diabetes in this study, but there were variations in the long-term efficacy, with some people improving and worsening, others maintaining strict control and a few subcutaneous insulin infusion 'non-responders'.
authors.affiliation: Diabetes Research Group, King's College London School of Medicine, Guy's Hospital, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Nixon
authors.forename: R
authors.initials: R
authors.lastname: Folwell
authors.forename: J C
authors.initials: JC
authors.lastname: Pickup
mesh_terms: D000328:Adult; D015992:Body Mass Index; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D007003:Hypoglycemia / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D055104:Infusions, Subcutaneous; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D007332:Insulin Infusion Systems / Q000009:adverse effects; D007333:Insulin Resistance; D008131:London; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D050177:Overweight / Q000150:complications; D011787:Quality of Health Care
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human