Long-term benefits of an integrated continuous glucose monitoring and insulin pump system for emergency admissions, hospitalization and metabolic control in a cohort of people with diabetes
ABSTRACT
Background:
There is evidence in the literature that the use of sensor-augmented insulin pumps in patients with high complexity diabetes improves metabolic control. However, there is no long-term information on clinical outcomes such as hospitalization or admission to the emergency room. This study describes the outcomes of metabolic control, incidence of hospitalizations and emergency room visits in a specific population using this technology
Objective:
We aimed to assess the long-term glycemic and clinical outcomes after the use of continuous subcutaneous insulin infusion and continuous glucose monitoring in diabetic patients.
Methods:
A retrospective cohort study was carried out in patients with diabetes previously treated with an intensive insulin regimen at a specialized diabetes treatment center, who required sensor-augmented insulin pump due to poor metabolic control. Glycated hemoglobin, severe hypoglycemic episodes, nonsevere hypoglycemic episodes, perception of hypoglycemia, and the incidence of emergency room visits and hospitalizations before and after treatment were evaluated.
Results:
Between January 2013 and August 2020, seventy-four patients with a median age of 36 years (interquartile range 27- 46 years) were included in the study with a median four-year of follow-up (interquartile range 2 – 7 years). We found a statistical reduction of glycated hemoglobin (8.35% vs. 7%; p = 0.0001), nonsevere hypoglycemic episodes (95.9% vs. 87.7%; p= 0.0142), emergency room visits (57.5% to 6.45%; p = 0.0001) and hospitalization (50% vs. 13.79%; p = 0.0001) after use of continuous subcutaneous insulin infusion.
Conclusions:
The use of sensor-augmented insulin pump associated with a strict follow-up program for patients with high complexity diabetes leads to a significant and sustained reduction in glycated hemoglobin and hypoglycemic episodes, as well as in the rate of emergency room visits and hospitalizations. These results encourage the adoption of this technology in patients who do not achieve metabolic control with optimal management of diabetes.
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