Higher fractional use of continuous subcutaneous insulin infusion (CSII) is associated with less diabetes related complications: Lessons from long term insulin pump users

BACKGROUND: Several studies have demonstrated that continuous subcutaneous insulin infusion (CSII) is effective in reducing complications in patients with type 1 diabetes (T1DM) in intermediate follow-up; moreover, a recent reports showed cardiovascular mortality reduction in comparison to multiple daily injections (MDI) at 6 years. The aim of this study is to evaluate the long-term outcomes of CSII in a cohort of adult type 1 diabetic patients in term of mortality, complications and life-threatening diseases. MATERIALS AND METHODS: This was a retrospective observational study on 141 patients who started CSII before January 2005. Long-term complications, CSII attrition, survival, life-threatening diseases, all mortality causes and the last follow-up HbA1c were recorded. RESULTS: The median duration of CSII at the time of analysis was 13 years. Mean age and duration of diabetes at CSII initiation were 38±7 years and 14±10 years, respectively. 11 (7.8%) patients suspended CSII, 5 (3.5%) died (only one-0.7%-for a cardiovascular event). 15 patients (11%) experienced at least one complication related to diabetes. At the last follow-up, mean HbA1c was 56±13 mmol/mol (7.3±1.0%; 36-119 mmol/mol, 5.4-13.0%). Patients who spent more than 55% of their disease duration on CSII developed less events/complications in comparison to patients spending less than 55%. No gender differences were observed. CONCLUSIONS: Our data demonstrate that in a clinical setting, long-term (>10 years) CSII treated patients have good glycaemic control at the last visit and a high rate of therapy adherence. The Fractional Time in which patients were treated by CSII is related to low long-term mortality and rate of complications. CSII may be considered an effective and durable therapeutic option for type 1 diabetes early in the course of the disease.