Aachen, Germany—Young type 1 diabetes patients had lower risk of diabetic ketoacidosis and severe hypoglycemia when using insulin pump therapy versus injections, a new German study suggests.

The report, published recently in JAMA, points out that past studies have indicated increased ketoacidosis risk associated with insulin-pump therapy in children with diabetes.

With the substantial increase in use of pumps for intensive insulin therapy in recent years, a study led by Aachen University researchers focused on more than 30,500 patients with type 1 diabetes who were younger than age 20 years and who had been diagnosed with diabetes more than a year earlier. All participants, who averaged age 14 years, either were treated either with insulin-pump therapy or with multiple insulin injections, defined as four or more a day.

The population-based cohort study was conducted between January 2011 and December 2015 in 446 diabetes centers participating in the Diabetes Prospective Follow-up Initiative in Germany, Austria, and Luxembourg.

Results indicate that pump therapy was associated with lower rates of severe hypoglycemia—9.55 versus 13.97 per 100 patient-years for injection therapy—as well as lower risk of diabetic ketoacidosis—3.64 versus 4.26 per 100 patient-years for injection therapy. In addition, both glycated hemoglobin levels and total daily insulin doses were lower with pump therapy versus injection therapy, the researchers report. Body mass index was unaffected, however.

“These findings provide evidence for improved clinical outcomes associated with insulin pump therapy compared with injection therapy in children, adolescents, and young adults with type 1 diabetes,” study authors conclude.

The study points out that the use of insulin pumps for intensive insulin therapy among patients with type 1 diabetes has substantially increased from 0.6% to 1.3% in 1995 to 44% to 47% between 2012 and 2016. Because pump therapy with rapid-acting insulin allows for a more physiologic insulin replacement, background information in the article notes that the treatment might contribute to improved metabolic control, thereby reducing the risk of long-term complications.
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