Publications

Improvement of Care & Outcome

INSULIN PUMP DISCONTINUATION

Pim Dekker, Henk-Jan Aanstoot, Theo Sas, Martine de Vries, Erwin Birnie, Dick Mul, Giesje Nefs

Prevalence of and reasons for discontinuation of continuous subcutaneous insulin infusion in people with type 1 diabetes: a systematic review. Diabetes Technol Ther. 2023 Apr 13. Online ahead of print.

Over the years insulin pumps as a means of administrating insulin to people with diabetes (PWDs) have yielded increasingly better results and more and more PWDs are using insulin pumps. Despite this, there is still a proportion of PWDs who eventually discontinue use of insulin pumps, due to various reasons. Earlier studies on insulin pump discontinuation have mostly focused on glycemic outcomes, hypoglycemia and quality of life, but not so much on the characteristics of PWDs who discontinue insulin pump use. This review aimed to include the most recent rates of insulin pump discontinuation and identify reasons for and factors associated with discontinuation among people with T1D.

 

The databases Embase, MEDLINE, PsycINFO and CINAHL were searched between 2000 and 2020, with search terms related to 1) type 1 diabetes, 2) discontinuation and 3) continuous subcutaneous insulin infusion. Of a total of 826 eligible publications, 67 were included after applying the in- and exclusion criteria. Data were then synthesized into themes for the following variables:

  • Indications for insulin pump initiation
  • PWD-reported reasons for insulin pump discontinuation
  • Factors associated with insulin pump discontinuation (i.e. not PWD-reported but data from electronic health records)

Key findings:

  • Most studies were published between 2010 and 2017 and were single-center, longitudinal prospective EHR studies
  • The top 3 indications for insulin pump treatment initiation comprised:
    1. Hyperglycemia
    2. Hypoglycemia
    3. Lifestyle flexibility
  • The median discontinuation percentage over the studies was 6.9% (IQR: 3.0-13.0%, range: 0–30%)
  • The most frequently mentioned reasons for insulin pump discontinuation were:
    1. Wear-related issues (e.g. having a device attached to the body, interference with daily activities sports activities discomfort and affected body image)
    2. Lack of improvement in glycemic outcomes (e.g. high glucose values, high HbA1c)
  • The most frequently reported factors associated with insulin pump discontinuation were:
    1. HbA1c
    2. Issues with following treatment recommendations (e.g. low motivation, low self-monitored blood glucose [SMBG[ frequency)

 

Concluding, the authors state

"Insulin pump discontinuation rates and PWD-reported reasons for and factors associated with insulin pump discontinuation in more recent studies were comparable to earlier reviews/meta-analyses, despite many developments in technology. ……… Of course ‘successful’ insulin pump treatment ……… will inherently include a knowledgeable and willing HCP team and a close match with PWDs wishes and needs" -

Please click here for the Pubmed link.

Also find our ATTD 2019 poster on this subject here.

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