Durable change in glycaemic control following intensive management of type 2 diabetes in the ACCORD clinical trial

We aimed to determine the persistence of glycaemic control 1 year after a limited period of intensive glycaemic management of type 2 diabetes

Evaluation of Pump Discontinuation and Associated Factors in the T1D Exchange Clinic Registry.

BackgroundThe objectives of this study were to examine factors associated with insulin pump discontinuation among children and adults followed longitudinally for 1 year in the multicenter T1D Exchange clinic registry, and to provide participant-reported reasons for stopping pump therapy.MethodsWe longitudinally followed 8935 participants of all ages using an insulin pump at the time of registry enrollment. Logistic regressions were used to identify demographic and clinical factors associated with pump discontinuation. Pump discontinuation was self-reported by participants on a first annual follow-up survey.ResultsThe overall frequency of pump discontinuation was 3%. Discontinuation was higher in adolescents (4%) and young adults (4%) than in younger children (3%) or older adults (1%). In multivariate analysis of children between 6 and <13 and 13 and <18 years, participants who discontinued pump use were more likely to have higher HbA1c levels at baseline (adjusted P < .001 for both). The top participant-reported reasons for discontinuing the pump included problems with wearability (57%), disliking the pump or feeling anxious (44%), and problems with glycemic control (30%).ConclusionsIn T1D Exchange registry participants, insulin pump discontinuation is uncommon, but more prevalent among adolescents and young adults, and youth with poor glycemic control. Given the known benefits of pump therapy, these populations should be targeted for support and education on troubleshooting pump use. Common reasons for discontinuation should also be considered in future device design and technological improvement

Durable change in glycaemic control following intensive management of type 2 diabetes in the ACCORD clinical trial

AIMS/HYPOTHESIS: We aimed to determine the persistence of glycaemic control 1 year after a limited period of intensive glycaemic management of type 2 diabetes. METHODS: 4119 ACCORD Trial participants randomized to target HbA(1c) <6.0% (42 mmol/mol) for 4.0±1.2 years were systematically transitioned to target HbA(1c) 7.0–7.9% (53–63 mmol/mol) and followed for an additional 1.1±0.2 years. Characteristics of participants with HbA(1c) <6.5% (48 mmol/mol) or ≥6.5% at transition were compared. Changes in BMI and glucose-lowering medications were compared between those ending with HbA(1c) <6.5% vs ≥6.5%. Poisson models were used to assess the independent effect of attaining HbA(1c) <6.5% before transition on ending with HbA(1c) <6.5%. RESULTS: Participants with pre-transition HbA(1c) <6.5% were older with shorter duration diabetes and took less insulin but more non-insulin glucose-lowering agents than those with higher HbA(1c). A total of 823 participants achieved a final HbA(1c) <6.5%, and had greater post-transition reductions in BMI, insulin dose and secretagogue and acarbose use than those with higher HbA(1c) (p<0.0001). HbA(1c) <6.5% at transition predicted final HbA(1c) <6.5% (crude RR 4.9 [95% CI 4.0, 5.9]; RR 3.9 [95% CI 3.2, 4.8] adjusted for demographics, co-interventions, pre-intervention HbA(1c), BMI and glucose-lowering medication, and post-transition change in both BMI and glucose-lowering medication). Progressively lower pre-transition HbA(1c) levels were associated with a greater likelihood of maintaining a final HbA(1c) of <6.5%. Follow-up duration was not associated with post-transition rise in HbA(1c). CONCLUSIONS/INTERPRETATION: Time-limited intensive glycaemic management using a combination of agents that achieves HbA(1c) levels below 6.5% in established diabetes is associated with glycaemic control more than 1 year after therapy is relaxed