title: Indications for Insulin Pump Therapy in Type 1 Diabetes and Associations With Glycemic Control.
abstract: Real-world data regarding indications for use of insulin pump remain sparse. We investigated characteristics among individuals with type 1 diabetes (T1D) in relation to indication for use of insulin pump (CSII). Comparison was made with T1D subjects using multiple daily injections (MDI).
  
  
  
  We included all individuals with T1D who had at least 1 registration in the National Diabetes Register during 2014-2015. Among 46 874 individuals, we excluded 2350 due to missing data. We examined 35 725 on MDI and 8799 on CSII regarding characteristics in relation to insulin delivery method, as well as association between insulin delivery and glycemic control (HbA1c) and presence of albuminuria.
  
  
  
  Unadjusted mean (SD) HbA1c was 63.84 (15.07) mmol/mol (7.99 [1.38]%) and 63.75 (13.19) mmol/mol (7.99 [1.21]%) in the MDI and CSII group, respectively. MDI and CSII users were on average 48.8 and 41.5 years old, respectively. MDI users were on average 26 years old and CSII users 17 years old at the time of diabetes diagnosis. Overall, a higher proportion of CSII users were females (53.5%). As compared with MDI, use of CSII was associated with up to 7.84 mmol/mol (0.72%) lower HbA1c in a multivariable adjusted model. Use of CSII was, however, not associated with risk of having albuminuria.
  
  
  
  CSII was used more frequently in younger individuals, early-onset diabetes, and problematic glycemic control. The use of CSII was associated with lower HbA1c among CSII users except from those who started CSII due to high HbA1c.
authors.affiliation: Faculty of Medical Sciences, Örebro University, Örebro, Sweden johan.jendle@oru.se.
authors.forename: Johan H
authors.initials: JH
authors.lastname: Jendle
authors.affiliation: Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden National Diabetes Register, Centre of Registers, Gothenburg, Sweden.
authors.forename: Araz
authors.initials: A
authors.lastname: Rawshani
authors.affiliation: Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden National Diabetes Register, Centre of Registers, Gothenburg, Sweden.
authors.forename: Ann-Marie
authors.initials: AM
authors.lastname: Svensson
authors.affiliation: National Diabetes Register, Centre of Registers, Gothenburg, Sweden.
authors.forename: Tarik
authors.initials: T
authors.lastname: Avdic
authors.affiliation: Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden National Diabetes Register, Centre of Registers, Gothenburg, Sweden.
authors.forename: Soffia
authors.initials: S
authors.lastname: Gudbjörnsdóttir
mesh_terms: D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; 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
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human
keywords: HbA1c; continuous insulin pump; pump indication; type 1 diabetes