Volume 2015 Supplement 1

Abstracts from the 8th APPES Biennial Scientific Meeting

Open Access

Continuous subcutaneous insulin infusion is associated with a reduced rate of microvascular complications

  • Bedowra Zabeen1,
  • Maria E Craig1,
  • Alison Pryke1,
  • Albert K F Chan1,
  • Yoon Hi Cho1,
  • Paul Benitez Aguirre1,
  • Stephen Hing2 and
  • Kim C Donaghue1
International Journal of Pediatric Endocrinology20152015(Suppl 1):O33

https://doi.org/10.1186/1687-9856-2015-S1-O33

Published: 28 April 2015

Aim

To determine whether use of continuous subcutaneous insulin infusion (CSII) is associated with lower rates of microvascular complications than use of multiple daily injections (MDI) in adolescents with type 1 diabetes from 2000-2014.

Methods

We assessed microvascular complications in 1152 adolescents aged 12-20 years with diabetes duration ≥ 5 years. Retinopathy was detected using seven–field fundal photography, albumin excretion rate (AER) using overnight urine collections or albumin-to-creatinine ratio (ACR) and peripheral nerve function by thermal and vibration threshold.

Results

Median age was 17 years [IQR 15-18] and median diabetes duration 9.0 [7.0-12.0] years. CSII was used by 29% and MDI 72%. CSII was associated with a lower rate of retinopathy than MDI (16% vs 22%; p=0.025) across the entire study period and in the latest time period with lower rate of AER elevation (≥ 7.5 μg/min)(26%vs 37%; p=0.012); microalbuminuria(1.3% vs 5.5%; p=0.016) and peripheral nerve abnormalities (27% vs 32% ; p 0.139) although the latter did not reach statistical significance.

In multivariable analysis, retinopathy was negatively associated with CSII Odds ratio (OR) 0.68 (95%CI:0.47-0.98) and positively with higher HbA1c OR 1.20 (1.08-1.32), older age at diagnosis 1.12 (1.02-1.22), longer diabetes duration 1.26 (1.15- 1.38) and lower height SDS 0.78 (0.67-0.91). Early elevation of AER was associated with higher HbA1c OR 1.33 (1.20-1.47), insulin dose 1.86 (1.22-2.82) and lower socioeconomic advantage 0.66 (0.46-0.94). Microalbuminuria was associated with higher insulin dose 2.64 (1.07-6.50) and HbA1c 1.34 (1.07-1.68). A peripheral nerve abnormality was negatively associated with CSII OR 0.66 (0.44-0.97), insulin dose OR 0.50 (0.26- 0.94) and positively with higher BMI SDS OR 1.31(1.06-1.63).

Conclusion

While the benefits of CSII on glycaemic control and quality of life are recognised, this is the first study to show a beneficial association of CSII vs MDI on microvascular complications.

Authors’ Affiliations

(1)
Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead
(2)
Ophthalmology Department, The Children’s Hospital at Westmead

Copyright

© Zabeen et al; licensee BioMed Central Ltd. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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