Insulin pump use and glycemic control in adolescents with type 1 diabetes: Predictors of change in method of insulin delivery across two years.
Few studies have explored durability of insulin pump use, and none have explored the link between depression and pump discontinuation. To examine the relationship between depressive symptoms [measured by the Children's Depression Inventory (CDI)], method of insulin delivery, and hemoglobin A1c (A1c), mixed models were used with data from 150 adolescents with type 1 diabetes (T1D) and visits every 6 months for 2 years. Of the 63% who used a pump, compared with multiple daily injections (MDI) at baseline, there were higher proportions who were non-minorities, had caregivers with a college degree, private insurance, and two caregivers in the home (p ≤ 0.01). After adjusting for time, sex, age, T1D duration, frequency of blood glucose monitoring, ethnicity, insurance, and caregiver number and education, baseline pump use was associated with -0.79% lower mean A1c [95% confidence interval (CI): -1.48, -0.096; p = 0.03]. For those using a pump at baseline, but switching to MDI during the study (n = 9), mean A1c was 1.38% higher (95% CI: 0.68, 2.08; p < 0.001) than that for those who did not switch method of delivery. A 10-point increase in CDI was associated with a 0.39% increase in A1c (95% CI: 0.16, 0.61; p = 0.001), independent of pump use. Regarding the temporal relationship between CDI score and changing method of insulin delivery, prior higher CDI score was associated with switching from pump to MDI (odds ratio = 1.21; 95% CI: 1.05, 1.39; p = 0.007). Clinicians should be aware of the associations between depressive symptoms, change in insulin delivery method, and the effect on glycemic control.
Division of Endocrinology, Department of Pediatrics, University of California San Francisco, San Francisco, CA, 94158, USA.
Jenise C
JC
Wong
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, 45229, USA.|Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA.
Lawrence M
LM
Dolan
Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of California San Francisco, San Francisco, CA, 94143, USA.
Tony T
TT
Yang
Division of Endocrinology, Department of Pediatrics, University of California San Francisco, San Francisco, CA, 94158, USA.
Korey K
KK
Hood
D000293:Adolescent; D001786:Blood Glucose / Q000187:drug effects; D003863:Depression / Q000097:blood / Q000209:etiology*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems; D008137:Longitudinal Studies; D008297:Male
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin
adolescent; depression; diabetes mellitus; insulin pump; type 1 diabetes