Long-term effects of continuous subcutaneous insulin infusion in adults with type 1 diabetes mellitus patients: Results of a public healthcare system.

Abstract Aim To evaluate the long-term clinical effect of continuous subcutaneous insulin infusion (CSII) in adult type 1 diabetes mellitus (T1DM) patients in a regional public healthcare system real-world scenario. Methods All adult T1DM patients on CSII for ≥10 years subjected to follow-up in the regional Castilla-La Mancha Public Health Service were included. The primary efficacy outcome was the variation in HbA1c during follow-up. Direct patient data were compiled through the web-based Spanish national registry on CSII therapy. Results A total of 69 T1DM adult patients were treated with insulin pumps for ≥10 years in our region. The mean age was 45.0 ± 10.5 years, with a T1DM duration of 13.9 ± 8.5 years. The mean duration of CSII therapy was 11.4 ± 2.1 years. The main indications for treatment were high glucose variability (39%), problematic hypoglycemia (26%), and HbA1c > 53 mmol/mol (7%) on multiple daily injections (20%). Sensor-augmented pump therapy was used by 31% of the patients. Glycosylated hemoglobin did not change during follow-up (58 ± 11 mmol/mol vs. 58 ± 11 mmol/mol; 7.5 ± 1.0 vs. 7.5 ± 1.0; p = 0.66). However, the percentage of patients with at least one episode of severe hypoglycemia during the last year and unnoticed hypoglycemia decreased from 36% to 7% (p = 0.006) and from 38% to 32% (p  Conclusions The reduction of severe hypoglycemia without deterioration of glycemic control can be sustained over long-term CSII therapy.