title: Insulin Pumps in Type 1 Diabetes with Mental Disorders: Real-Life Clinical Data Indicate Discrepancies to Recommendations.
abstract: BACKGROUND
  The latest American Association of Clinical Endocrinologists/American College of Endocrinologists consensus statement published in 2014 does not recommend continuous subcutaneous insulin infusion (CSII) in patients with mental health problems. This study investigated the use and discontinuation of CSII in daily routine care of type 1 diabetes (T1D) patients with or without comorbid mental disorders.
  
  
  METHODS
  Insulin-treated T1D patients (n = 48,700) between 5 and 30 years of age (median [interquartile range], 15.6 [12.0-17.7] years) from the German/Austrian diabetes patient follow-up registry (DPV) were studied. A comorbid diagnosis and/or specific treatment of mental disorder was documented in 3,158 (6.5%) patients: attention-deficit hyperactivity disorder (ADHD), n = 1,352; depression, n = 692; eating disorders, n = 395; needle phobia, n = 319; anxiety/obsessive compulsive disorder (OCD), n = 231; and psychosis and/or neuroleptic medication, n = 169. Multivariable logistic regression with age, sex, diabetes duration, and migration background as independent variables was used to compare groups.
  
  
  RESULTS
  After adjustment for confounders, use of CSII was more common in patients with depression (41.5%), anxiety/OCD (41.4%), or needle phobia (75.8%) compared with patients without mental disorders (34.6%) (each P < 0.05). By contrast, psychotic patients (26.2%, P < 0.05) used CSII less often, and patients with ADHD (36.3%) or eating disorders (33.9%) used it with a similar frequency. Compared with patients without mental disorders (5.1%), the rate of CSII discontinuation was higher in patients with ADHD (9.7%), depression (8.2%), or eating disorders (10.0%) (P < 0.05, respectively) but similar in patients with anxiety/OCD (6.0%), psychosis (4.2%), or needle phobia (5.3%).
  
  
  CONCLUSIONS
  In routine diabetes care, CSII use and discontinuation vary widely among T1D patients with mental disorders and indicate clear differences from the latest recommendations.
authors.affiliation: 1 Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, University of Ulm , Ulm, Germany . *
authors.forename: Nicole
authors.initials: N
authors.lastname: Prinz
authors.affiliation: 2 Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center at Heinrich-Heine-University Düsseldorf , Düsseldorf, Germany . *
authors.forename: Christina
authors.initials: C
authors.lastname: Bächle
authors.affiliation: 3 Clinic for Children and Adolescents, Dr. Horst-Schmidt-Kliniken GmbH , Wiesbaden, Germany .
authors.forename: Marianne
authors.initials: M
authors.lastname: Becker
authors.affiliation: 4 Department of Pediatric and Adolescent Medicine, Medical University Vienna , Vienna, Austria .
authors.forename: Gabriele
authors.initials: G
authors.lastname: Berger
authors.affiliation: 5 Pediatric Endocrinology and Diabetology, University Hospital for Children and Adolescents , Campus Virchow, Charité-University Hospital Berlin , Berlin, Germany .
authors.forename: Angela
authors.initials: A
authors.lastname: Galler
authors.affiliation: 6 Hospital for Children and Adolescents, Sana Hospital Berlin Lindenhof , Berlin, Germany .
authors.forename: Holger
authors.initials: H
authors.lastname: Haberland
authors.affiliation: 7 Department of Child and Adolescent Psychiatry and Neurology, Community Hospital , Herdecke, Germany .
authors.forename: Michael
authors.initials: M
authors.lastname: Meusers
authors.affiliation: 8 Children's Hospital, Hospitals of the City of Cologne , Cologne, Germany .
authors.forename: Joaquina
authors.initials: J
authors.lastname: Mirza
authors.affiliation: 9 Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm , Ulm, Germany .
authors.forename: Paul L
authors.initials: PL
authors.lastname: Plener
authors.affiliation: 10 Clinic for Child and Adolescent Medicine, University Hospital Schleswig-Holstein , Campus Lübeck, Lübeck, Germany .
authors.forename: Simone
authors.initials: S
authors.lastname: von Sengbusch
authors.affiliation: 11 Clinic for Children and Adolescents, St. Vincenz Hospital , Christophorus Clinics, Coesfeld, Germany .
authors.forename: Michaela
authors.initials: M
authors.lastname: Thienelt
authors.affiliation: 1 Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, University of Ulm , Ulm, Germany . *
authors.forename: Reinhard W
authors.initials: RW
authors.lastname: Holl
mesh_terms: D000293:Adolescent; D000328:Adult; D001317:Austria; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000523:psychology*; D005260:Female; D005858:Germany; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D007332:Insulin Infusion Systems / Q000523:psychology / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000523:psychology*; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D012042:Registries; D055815:Young Adult
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin