Effect of 4 years subcutaneous insulin infusion treatment on albuminuria, kidney function and HbA1c compared with multiple daily injections: a longitudinal follow‐up study. Issue 11 (6th October 2015)

• Record Type: Journal Article
• Authors: Rosenlund, S.; Hansen, T. W.; Andersen, S.; Rossing, P.
• Is Part Of: Diabetic medicine. Volume 32:Issue 11(2015:Nov.)
• Page Start: 1445
• Page End: 1452
• Publication Date: 2015-10-06
• Subjects: Diabetes -- Periodicals; 616.462
• DOI: 10.1111/dme.12950
• Languages: English
• ISSNs: 0742-3071

Abstract

<abstract abstract-type="main" id="dme12950-abs-0001"> <title>Abstract</title> <sec id="dme12950-sec-0001" sec-type="section"> <title>Aim</title> <p>The effect of insulin pump [continuous subcutaneous insulin infusion (CSII)] treatment on diabetes complications in a modern clinical setting is largely unknown. We investigated the effect of 4 years CSII treatment on HbA<sub>1c, </sub> albuminuria and kidney function compared with multiple daily injections (MDI) in a single‐centre clinical setting.</p> </sec> <sec id="dme12950-sec-0002" sec-type="section"> <title>Methods</title> <p>All patients initiating CSII treatment from 2004 to 2010 and followed for at least 4 years were included in the study: 193 people with Type 1 diabetes were matched (1 : 2) with 386 patients treated with MDI in the same period. Matching was based on diabetes duration, gender, HbA<sub>1c</sub> and normo‐, micro‐ or macroalbuminuria at baseline. Urinary albumin/creatinine ratio (UACR) was measured yearly and annual change assessed from linear regression.</p> </sec> <sec id="dme12950-sec-0003" sec-type="section"> <title>Results</title> <p>CSII‐ vs. MDI‐treated patients were comparable at baseline. After 4 years, HbA<sub>1c</sub> was 62 ± 11 vs. 68 ± 11 mmol/mol (7.8 ± 1.0 vs. 8.4 ± 1.0%) (<italic>P < </italic>0.001). Annual UACR change in CSII‐ vs. MDI‐treated patients was [mean (95% confidence interval)] −10.1 (−13.3; −6.8) vs. −1.2 (−3.6; 0.9)% (<italic>P < </italic>0.001). Reduction in UACR was significantly associated with CSII treatment after adjustment for age, gender, diabetes duration, estimated GFR, UACR, mean arterial pressure, HbA<sub>1c</sub>, cholesterol, renin–angiotensin–aldosterone system inhibition, anti‐hypertensive treatment and smoking (<italic>P < </italic>0.001). This remained significant (<italic>P < </italic>0.001) when only including patients on stable renin–angiotensin–aldosterone system inhibition during follow‐up (<italic>n</italic> = 465).</p> </sec> <sec id="dme12950-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Treatment with CSII over 4 years independently reduced HbA<sub>1c</sub> and UACR compared with MDI. Reduced UACR may be due to less glycaemic variability because the effect of CSII on HbA<sub>1c</sub> could only partially explain the effect. This needs confirmation in randomized controlled trials.</p> </sec> </abstract>