title: Prevalence of Insulin Pump Therapy and Its Association with Measures of Glycemic Control: Results from the Canadian Study of Longevity in Type 1 Diabetes.
abstract: We aimed to determine cross-sectional insulin pump prevalence and factors associated with measures of glycemic control as a secondary analysis in a long-standing type 1 diabetes mellitus (T1DM) national cohort.
  
  
  
  Canadian participants with ≥50 years of T1DM (n = 305) were administered a comprehensive mail-based questionnaire including acquisition of contemporaneous laboratory results. Factors associated with pump use, glycosylated hemoglobin (HbA1c), and hypoglycemia were analyzed by regression.
  
  
  
  The 305 participants had a median age of 65 [interquartile range, 59, 71] years, median diabetes duration of 54 [51, 59] years, and mean HbA1c level of 7.5 ± 1.1%. Prevalence of pump use was 44% (133/305), with median duration of use 8 [4, 13] years. Compared with the non-pump subgroup, the pump subgroup had numerically lower but similar HbA1c levels (7.4 ± 0.9% vs. 7.6 ± 1.2%; P = 0.22) and reported greater numbers of minor hypoglycemia events (6.5 vs. 5.1 events/patient·month; P = 0.004) and fewer severe hypoglycemia events (0.5 vs. 1.3 events/patient·year; P = 0.02) in the past year. More frequent daily glucose tests and more frequent minor hypoglycemia events-but not pump therapy or its prescription parameters-were independently associated with lower HbA1c level in multivariable regression. However, use of insulin pump and habitual use of continuous glucose monitoring (≥1 week/month) were each independently associated with lower risk of severe hypoglycemia (risk ratio = 0.50 [P < 0.0001] and 0.30 [P = 0.001], respectively).
  
  
  
  Insulin pump and continuous glucose monitoring technologies were associated with lower risk of severe hypoglycemia, while frequent daily glucose testing was associated with lower HbA1c level. These findings imply that basic self-management skill and technology play complementary roles in glycemic control among older adults with long-standing T1DM.
authors.affiliation: 1 Division of Endocrinology and Metabolism, Department of Medicine, Mount Sinai Hospital, University of Toronto , Toronto, Ontario, Canada .
authors.forename: Geneviève
authors.initials: G
authors.lastname: Boulet
authors.affiliation: 1 Division of Endocrinology and Metabolism, Department of Medicine, Mount Sinai Hospital, University of Toronto , Toronto, Ontario, Canada .
authors.forename: Elise M
authors.initials: EM
authors.lastname: Halpern
authors.affiliation: 1 Division of Endocrinology and Metabolism, Department of Medicine, Mount Sinai Hospital, University of Toronto , Toronto, Ontario, Canada .
authors.forename: Leif E
authors.initials: LE
authors.lastname: Lovblom
authors.affiliation: 1 Division of Endocrinology and Metabolism, Department of Medicine, Mount Sinai Hospital, University of Toronto , Toronto, Ontario, Canada .
authors.forename: Alanna
authors.initials: A
authors.lastname: Weisman
authors.affiliation: 1 Division of Endocrinology and Metabolism, Department of Medicine, Mount Sinai Hospital, University of Toronto , Toronto, Ontario, Canada .
authors.forename: Johnny-Wei
authors.initials: JW
authors.lastname: Bai
authors.affiliation: 1 Division of Endocrinology and Metabolism, Department of Medicine, Mount Sinai Hospital, University of Toronto , Toronto, Ontario, Canada .
authors.forename: Devrim
authors.initials: D
authors.lastname: Eldelekli
authors.affiliation: 2 Research Division, Joslin Diabetes Center , Boston, Massachusetts.
authors.forename: Hillary A
authors.initials: HA
authors.lastname: Keenan
authors.affiliation: 3 Departments of Ophthalmology and Vision Sciences and of Medicine, University of Toronto, Toronto , Ontario, Canada .
authors.forename: Michael H
authors.initials: MH
authors.lastname: Brent
authors.affiliation: 4 Joint Department of Medical Imaging, Division of Cardiothoracic Radiology, University Health Network , Toronto, Ontario, Canada .
authors.forename: Narinder
authors.initials: N
authors.lastname: Paul
authors.affiliation: 5 The Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Krembil Neuroscience Centre, Division of Neurology, Department of Medicine, University Health Network, University of Toronto , Toronto, Ontario, Canada .
authors.forename: Vera
authors.initials: V
authors.lastname: Bril
authors.affiliation: 6 Division of Nephrology, Department of Medicine, University of Toronto , Toronto, Ontario, Canada .
authors.forename: David Z I
authors.initials: DZ
authors.lastname: Cherney
authors.affiliation: 1 Division of Endocrinology and Metabolism, Department of Medicine, Mount Sinai Hospital, University of Toronto , Toronto, Ontario, Canada .
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Perkins
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin