Long-term study of tubeless insulin pump therapy compared to multiple daily injections in youth with type 1 diabetes: Data from the German/Austrian DPV registry

Objective: To examine glycemic control in youth with type 1 diabetes (T1D) who switched from multiple daily injections (MDI) to a tubeless insulin pump (Omnipod Insulin Management System, Insulet Corporation, Billerica, Massachusetts) compared to patients who continued MDI therapy over a 3-year time period. Research Design and Methods: This retrospective analysis of the German/Austrian Diabetes Patienten Verlaufsdokumentation registry included data from 263 centers and 2529 patients <20 years (n=660 tubeless insulin pump; n=1869 MDI) who initiated treatment on a tubeless insulin pump as of January 1, 2013 and had 1year of data preswitch from MDI and 3years of data postswitch to a tubeless pump. Outcomes included the change in glycated hemoglobin (HbA1c), insulin dose, and body mass index (BMI) SD score (SDS). Results: Youth with T1D who switched from MDI therapy to a tubeless insulin pump showed better glycemic control at 1year compared to patients who continued MDI treatment, adjusted mean +/- SE: 7.5% +/- 0.03% (58 mmol/mol) vs 7.7% +/- 0.02% (61 mmol/mol); P<.001, with no between-group difference at 2 and 3years. Total daily insulin dose was lower (P<.001) in the tubeless insulin pump group, 0.80 +/- 0.01, 0.81 +/- 0.01, and 0.85 +/- 0.01 U/kg, vs the MDI group, 0.89 +/- 0.01, 0.94 +/- 0.01, and 0.97 +/- 0.01 U/kg, at 1, 2, and 3years, respectively (all P<.001). BMI SDS increased in both groups and was not different over time. Conclusions: Treatment with a tubeless insulin pump in youth with T1D was associated with improvements in glycemic control compared to MDI after 1year and appears to be an effective alternative to MDI.