What factors are associated with success with insulin pumps?Diabetes UK conference gran

Brackley, SM

Davenport, K

Evans, ML

Gurnell, E

Hartnell, S

Apollo (Cambridge)

SM Brackley*, S Hartnell, K Davenport, E Gurnell, ML Evans Institute of Metabolic Science & University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK What factors are associated with success with insulin pumps? Introduction • Over 13,000 adults and 5000 children in the UK use insulin pump (continuous subcutaneous insulin infusion—CSII) therapy1. • Whilst CSII therapy can be very successful, not all benefit to the same degree • We aimed to determine factors associated with improved blood glucose control on a population and individual level.  Methods: • Observational retrospective analysis of Medtronic Carelink database from 481 adults in a single large UK pump service • 14 “behavioural” variables and 5 glycaemic outcome measures were analysed using an R script on a population and individual basis Population-based analysis Specific methods • Mean values were generated for each patient dataset from 2015-2018 • A linear regression was performed for each behaviour-outcome combination • The difference in each outcome was calculated based on a one interquartile range in-crease in each behaviour (e.g. what is the HbA1c in patients with 3 more blood glucose readings per day?)  Results • Multiple factors were associated with improved HbA1c (shown on right) • For example, patients with an average of 3.16 more daily blood glucose readings had a lower HbA1c by 11.5% (CI 8.8-14.2%, p < 10-14). • Similar results were found for mean blood glucose readings, proportion of “time in range” and proportion of readings with Level 1 or 2 hyperglycaemia  • No correlations were found between behaviours and proportion of readings within Level 1 or 2 hypoglycaemia • No correlation was found between the variance of basal rates and any outcome measure Individual-based analysis Specific methods • Mean values were generated for each patient dataset per day. • A linear regression was performed for each behaviour-outcome combination per patient • Where the model generated for a given patient was sig-nificant (p value <0.05 / number of patients), an effect size was calculated, using the patient’s own IQR for the behaviour  Results • A lower mean blood glucose correlated with more read-ings per day, a higher proportion of insulin being deliv-ered by the basal rate and more (shown on right) • Whilst these factors reduced the time in hyperglycaemia, they also correlated with more hypoglycaemic readings • Higher blood glucose readings were associated with more insulin being delivered and a greater number of bo-luses  Conclusions • The most significant behaviour associated with improved HbA1c and glycaemic control was the number of readings taken per day • On a population level, having more user engagement (including more basal rates, boluses, carbohydrate input etc) correlated with better blood glucose control • On an individual level, days with better glycaemic control tended to have more BG readings and more variance in basal rates References 1. White, H. D. et al. The U.K. service level audit of insulin pump therapy in adults. Diabet. Med. J. Br. Diabet. Assoc. 31, 412–418 (2014).   Funding • Diabetes UK conference grant 

What factors are associated with success with insulin pumps?

https://www.repository.cam.ac.uk/bitstream/1810/291147/3/Simon%2bposter%2bdraft%20%281%29.pdf

What factors are associated with success with insulin pumps?

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