title: Sustained benefit of continuous subcutaneous insulin infusion on glycaemic control and hypoglycaemia in adults with Type 1 diabetes.
abstract: OBJECTIVE
  To evaluate the sustainability of the benefits of continuous subcutaneous insulin infusion therapy in routine practice in a cohort of adults with diabetes.
  
  
  METHODS
  The clinical records of all adults starting continuous subcutaneous insulin infusion over 12 years at our centre were included in this study. Baseline and mean annual HbA(1c) levels were recorded. The frequency of mild-to-moderate and severe hypoglycaemia and hypoglycaemia awareness were analysed in a subgroup.
  
  
  RESULTS
  Adequate data were available from 327 patients, of whom 71% were female. The patients' mean ± sd age was 41 ± 14 years, the mean ± sd (range) follow-up for continuous subcutaneous insulin infusion was 4.3 ± 2.7 (1-12) years. The mean ± sd HbA(1c) concentration fell by 8 ± 5 mmol/mol (0.7 ± 0.5%) at year 1 [to 63 ± 12 mmol/mol from 70 ± 18 mmol/mol (7.9 ± 1.1% from 8.6 ± 1.6%); P < 0.0005], sustained to year 5. In patients with initial poor control, HbA(1c) dropped by 12 ± 11 mmol/mol (1.1 ± 1.0%; P < 0.0005) at year 1, sustained to year 6. The percentage of patients with ≥ 5 mild to moderate hypoglycaemic episodes per week fell from 29 to 12% (n = 163; P = 0.006). In the subgroup (n = 87; follow-up 2.5 ± mean ± sd 1.1 years), the frequency of severe hypoglycaemia fell from 0.6 ± 1.7 episodes per patient per year to 0.3 ± 0.9 (P = 0.047). Of 24 patients with impaired awareness of hypoglycaemia (Gold score ≥ 4), the mean ± sd Gold score improved from 4.9 ± 0.9 to 3.8 ± 1.7 (P = 0.011). Nine people regained awareness. No deterioration in HbA(1c) was seen in the hypoglycaemia-prone groups.
  
  
  CONCLUSIONS
  The benefits of continuous subcutaneous insulin infusion with regard to improving glycaemic control and reducing hypoglycaemia frequency, along with improvement in hypoglycaemia awareness without deterioration in glycaemic control, can be sustained over several years in clinical practice.
authors.affiliation: Department of Diabetes, King's College Hospital, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: Beato-Víbora
authors.affiliation: Department of Diabetes, King's College Hospital, London, UK.
authors.forename: E
authors.initials: E
authors.lastname: Yeoh
authors.affiliation: Department of Diabetes, King's College Hospital, London, UK.
authors.forename: H
authors.initials: H
authors.lastname: Rogers
authors.affiliation: Department of Diabetes, King's College Hospital, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Hopkins
authors.affiliation: Diabetes Research Group, King's College London, London, UK.
authors.forename: S A
authors.initials: SA
authors.lastname: Amiel
authors.affiliation: Diabetes Research Group, King's College London, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: Choudhary
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000178:diet therapy / Q000188:drug therapy*; D003927:Diet, Diabetic; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D007722:Health Knowledge, Attitudes, Practice; D006785:Hospitals, University; D006801:Humans; D006943:Hyperglycemia / Q000503:physiopathology / Q000517:prevention & control*; D007003:Hypoglycemia / Q000503:physiopathology / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D007332:Insulin Infusion Systems; D008131:London; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human