title: Long-Term Effects of Continuous Subcutaneous Insulin Infusion on Glucose Control and Microvascular Complications in Patients With Type 1 Diabetes.
abstract: We investigated the long-term effects of continuous subcutaneous insulin infusion (CSII) on glucose control and microvascular complications in patients with type 1 diabetes (T1D).
  
  
  
  A total of 157 patients (59 M/98 W; age 39.1 ± 14.8 years) with T1D who switched from multiple daily injections to CSII and used CSII for at least one year were included. HbA1c levels and status of microvascular complications before and while under CSII were analyzed, retrospectively.
  
  
  
  The follow-up period was 4.0 ± 1.5 years. HbA1c significantly decreased from 8.4 ± 1.3 to 7.7 ± 1.3% (68 ± 14 to 61 ± 14 mmol/mol) after 1-year CSII and remained lower than pre-CSII levels during four years. Patients with pre-CSII HbA1c >8.0% (64 mmol/mol) showed significant improvement of HbA1c for four years, while those with pre-CSII HbA1c <8.0% showed no significant change. The prevalence of retinopathy, albuminuria, and chronic kidney disease (CKD) were respectively 39%, 12%, and 9% at CSII initiation. During follow-up, the incidence of retinopathy, albuminuria, and CKD were 3.6, 2.5 and 1.4/100 patient-years. Onset or progression of retinopathy occurred in 16 (27.1%) patients with diabetes duration >15 years, and in three (4.3%) patients with diabetes duration <15 years ( P < .01).
  
  
  
  CSII was effective in improving HbA1c for up to four years, specifically in patients with HbA1c >8% (64 mmol/mol) prior to CSII. Incidence and progression rates of retinopathy and albuminuria were low, particularly in patients with a diabetes duration <15 years at CSII initiation. These results argue for not delaying a proposal of CSII initiation in T1D with sustained HbA1c >8% (64 mmol/mol).
authors.affiliation: 1 Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Montpellier, France.|2 Department of Endocrinology, Diabetes, Metabolic Diseases, Hospices Civils de Lyon, Lyon-South University Hospital, Lyon, France.
authors.forename: Lucien
authors.initials: L
authors.lastname: Marchand
authors.affiliation: 1 Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Montpellier, France.
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Kawasaki-Ogita
authors.affiliation: 3 Institute of Functional Genomics, University of Montpellier, Montpellier, France.
authors.forename: Jérome
authors.initials: J
authors.lastname: Place
authors.affiliation: 1 Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Montpellier, France.
authors.forename: Corinne
authors.initials: C
authors.lastname: Fayolle
authors.affiliation: 1 Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Montpellier, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Lauton
authors.affiliation: 1 Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Montpellier, France.
authors.forename: Françoise
authors.initials: F
authors.lastname: Boulet
authors.affiliation: 1 Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Montpellier, France.|3 Institute of Functional Genomics, University of Montpellier, Montpellier, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Farret
authors.affiliation: 1 Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Montpellier, France.|3 Institute of Functional Genomics, University of Montpellier, Montpellier, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Renard
mesh_terms: D000328:Adult; D048909:Diabetes Complications / Q000453:epidemiology*; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D055104:Infusions, Subcutaneous; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human
keywords: continuous subcutaneous insulin infusion; glucose control; insulin pump; long-term effects; microvascular complications; type 1 diabetes