Continuous subcutaneous insulin infusion is associated with a reduced rate of microvascular complications
© Zabeen et al; licensee BioMed Central Ltd. 2015
Published: 28 April 2015
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.
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.
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).
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.
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