Insulin Pumps Are Effective and Durable in Adult-Onset Type 1 Diabetes

Continuous subcutaneous insulin infusion (CSII) is considered as a valuable therapeutic option for people with diabetes, but there is a substantial lack of studies on long-term effectiveness of CSII in type 1 diabetes (T1D) with adult onset. To assess the effectiveness and durability of CSII in people with adult onset T1D, we studied 70 people treated with CSII (male/female = 35/35) and with age at onset > 35 years (age at onset = 44.7 ± 8.8 years [mean ± DS]; age at CSII commencement = 49.1 ± 10.4 years). Main outcome was the mean of glycosylated hemoglobin (HbA1c) values obtained throughout the follow-up (MHbA1c). Secondary outcomes were the the yearly mean of HbA1c values (mHbA1c). After a follow-up of 1-8 years, MHbA1c resulted signifi cantly decreased from baseline HbA1c (respectively, 7.71% ± 1.08 SDS vs. 8.21% ± 1.20; p < 0.001); the latter was directly related to MHbA1c and was the only predictor of MHbA1c (R2 = 0.427). HbA1c decreased signifi cantly from a baseline value of 8.2% ± 1.2 to mHbA1c values of 7.8% ± 1.2 (1st year), 7.6% ± 1.3 (2nd year), 7.6% ± 1.4 (3rd year), 7.7% ± 1.2 (4th year) (ANOVA for repeated measures: p < 0.05; F = 2.70), with a non signifi cant reduction from the 5th year (Figure 1). In conclusion, our study suggests that CSII in T1D with adult onset is: 1.) effective to decrease HbA1c throughout a prolonged follow-up, with a signifi cant trend for 4 years; 2.) more effective when baseline HbA1c is lower.