Effect of 4 years subcutaneous insulin infusion treatment on albuminuria, kidney function and HbA1c compared with multiple daily injections: a longitudinal follow-up study.
OBJECTIVE
The effect of insulin pump [continuous subcutaneous insulin infusion (CSII)] treatment on diabetes complications in a modern clinical setting is largely unknown. We investigated the effect of 4 years CSII treatment on HbA(1c), albuminuria and kidney function compared with multiple daily injections (MDI) in a single-centre clinical setting.


METHODS
All patients initiating CSII treatment from 2004 to 2010 and followed for at least 4 years were included in the study: 193 people with Type 1 diabetes were matched (1 : 2) with 386 patients treated with MDI in the same period. Matching was based on diabetes duration, gender, HbA(1c) and normo-, micro- or macroalbuminuria at baseline. Urinary albumin/creatinine ratio (UACR) was measured yearly and annual change assessed from linear regression.


RESULTS
CSII- vs. MDI-treated patients were comparable at baseline. After 4 years, HbA(1c) was 62 ± 11 vs. 68 ± 11 mmol/mol (7.8 ± 1.0 vs. 8.4 ± 1.0%) (P < 0.001). Annual UACR change in CSII- vs. MDI-treated patients was [mean (95% confidence interval)] -10.1 (-13.3; -6.8) vs. -1.2 (-3.6; 0.9)% (P < 0.001). Reduction in UACR was significantly associated with CSII treatment after adjustment for age, gender, diabetes duration, estimated GFR, UACR, mean arterial pressure, HbA(1c), cholesterol, renin-angiotensin-aldosterone system inhibition, anti-hypertensive treatment and smoking (P < 0.001). This remained significant (P < 0.001) when only including patients on stable renin-angiotensin-aldosterone system inhibition during follow-up (n = 465).


CONCLUSIONS
Treatment with CSII over 4 years independently reduced HbA(1c) and UACR compared with MDI. Reduced UACR may be due to less glycaemic variability because the effect of CSII on HbA(1c) could only partially explain the effect. This needs confirmation in randomized controlled trials.
Steno Diabetes Center, Gentofte, Denmark.|Nordsjaellands Hospital, Hilleroed, Denmark.
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S
Rosenlund
Steno Diabetes Center, Gentofte, Denmark.
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TW
Hansen
Nordsjaellands Hospital, Hilleroed, Denmark.
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S
Andersen
Steno Diabetes Center, Gentofte, Denmark.|Aarhus University, Aarhus, Denmark.|University of Copenhagen, Copenhagen, Denmark.
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P
Rossing
D000328:Adult; D000419:Albuminuria / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000453:epidemiology / Q000517:prevention & control*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D007332:Insulin Infusion Systems; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control; D012306:Risk
D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human