title: Insulin Pump Therapy Is Associated with Lower Rates of Retinopathy and Peripheral Nerve Abnormality.
abstract: OBJECTIVE
  To compare rates of microvascular complications in adolescents with type 1 diabetes treated with continuous subcutaneous insulin infusion (CSII) versus multiple daily injections (MDI).
  
  
  METHODS
  Prospective cohort of 989 patients (aged 12-20 years; diabetes duration >5 years) treated with CSII or MDI for >12 months. Microvascular complications were assessed from 2000-14: early retinopathy (seven-field fundal photography), peripheral nerve function (thermal and vibration threshold testing), autonomic nerve abnormality (heart rate variability analysis of electrocardiogram recordings) and albuminuria (albumin creatinine ratio/timed overnight albumin excretion). Generalized estimating equations (GEE) were used to examine the relationship between treatment and complications rates, adjusting for socio-economic status (SES) and known risk factors including HbA1c and diabetes duration.
  
  
  RESULTS
  Comparing CSII with MDI: HbA1C was 8.6% [70mmol/mol] vs. 8.7% [72 mmol/mol]) (p = 0.7), retinopathy 17% vs. 22% (p = 0.06); microalbuminuria 1% vs. 4% (p = 0.07), peripheral nerve abnormality 27% vs. 33% (p = 0.108) and autonomic nerve abnormality 24% vs. 28% (p = 0.401). In multivariable GEE, CSII use was associated with lower rates of retinopathy (OR 0.66, 95% CI 0.45-0.95, p = 0.029) and peripheral nerve abnormality (OR 0.63, 95% CI 0.42-0.95, p = 0.026), but not albuminuria (OR 0.46, 95% CI 0.10-2.17, p = 0.33). SES was not associated with any of the complication outcomes.
  
  
  CONCLUSIONS
  In adolescents, CSII use is associated with lower rates of retinopathy and peripheral nerve abnormality, suggesting an apparent benefit of CSII over MDI independent of glycemic control or SES.
authors.affiliation: Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.|Department of Paediatrics & Changing Diabetes in Children Program, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders, Dhaka, Bangladesh.
authors.forename: Bedowra
authors.initials: B
authors.lastname: Zabeen
authors.affiliation: Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.|School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.|Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Maria E
authors.initials: ME
authors.lastname: Craig
authors.affiliation: Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.|School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Sohaib A
authors.initials: SA
authors.lastname: Virk
authors.affiliation: Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
authors.forename: Alison
authors.initials: A
authors.lastname: Pryke
authors.affiliation: Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
authors.forename: Albert K F
authors.initials: AK
authors.lastname: Chan
authors.affiliation: Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.|Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Yoon Hi
authors.initials: YH
authors.lastname: Cho
authors.affiliation: Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.|Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Paul Z
authors.initials: PZ
authors.lastname: Benitez-Aguirre
authors.affiliation: Ophthalmology Department, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Hing
authors.affiliation: Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.|Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Kim C
authors.initials: KC
authors.lastname: Donaghue
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000188:drug therapy*; D003930:Diabetic Retinopathy / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007332:Insulin Infusion Systems; D008297:Male; D010525:Peripheral Nerves / Q000473:pathology*; D011446:Prospective Studies; D055815:Young Adult