P Ross1, A R Gray2, J Milburn3, I M Kumarasamy4, F Wu4, S Farrand5, J Armishaw6, E Wiltshire7, J Rayns3,5, P Tomlinson1, B J Wheeler8,9. 1. Department of Women's and Children's Health, University of Otago, PO Box 913, Dunedin, 9054, New Zealand. 2. Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand. 3. Paediatric Endocrinology, Southern District Health Board, Dunedin, New Zealand. 4. Diabetes Centre, Auckland District Health Board, Auckland, New Zealand. 5. Department of Endocrinology, Southern District Health Board, Dunedin, New Zealand. 6. Department of Paediatrics, Tauranga Public Hospital, Tauranga, New Zealand. 7. Department of Children's Health, University of Otago, Wellington, New Zealand. 8. Department of Women's and Children's Health, University of Otago, PO Box 913, Dunedin, 9054, New Zealand. ben.wheeler@otago.ac.nz. 9. Paediatric Endocrinology, Southern District Health Board, Dunedin, New Zealand. ben.wheeler@otago.ac.nz.
Abstract
AIMS: While there have been many outcome-focussed studies examining insulin pump therapy, only a few have looked at potential adverse events (AEs), with none examining the relationship between AEs and pump/infusion set type, ethnicity or socio-economic status. In addition, current data on the incidence and characteristics of pump-associated AEs are confined to one paediatric centre. We aimed to describe the incidence, characteristics and potential predictors of insulin pump-associated AEs in New Zealand adults and children with T1DM. METHODS: We approached adults and families of children with T1DM on insulin pumps in four main New Zealand centres. Participants completed a questionnaire examining pump-related issues they had experienced in the preceding 12 months. RESULTS: Response rate was 64 % with 174 of 270 eligible people participating in the study. 84 % of subjects reported one or more AEs, with an overall AE incidence of 3.42 per person/year (95 % CI 3.14, 3.73). An event serious enough to require a hospital presentation occurred in 9.8 %, all but one reporting high ketones or diabetic ketoacidosis (DKA). Set/site problems were the AE most commonly reported (by 53 % of respondents), followed by cutaneous complications (43 %) and pump malfunction (38 %). Few predictors of AEs (of any type) were found; however, a negative binomial regression model found that a longer duration of pumping (p = 0.018) and age <18 years (p = 0.043) were both associated with fewer AEs (all types combined). CONCLUSIONS: Insulin pump-associated AEs are very common. However, few variables are predictive of them with no relationships seen with glycaemic control, socio-economic status, pump manufacturer or infusion set type. Based on these findings, AEs should be anticipated in both adults and children, with anticipatory patient education and training recommended for their successful and safe use.
AIMS: While there have been many outcome-focussed studies examining insulin pump therapy, only a few have looked at potential adverse events (AEs), with none examining the relationship between AEs and pump/infusion set type, ethnicity or socio-economic status. In addition, current data on the incidence and characteristics of pump-associated AEs are confined to one paediatric centre. We aimed to describe the incidence, characteristics and potential predictors of insulin pump-associated AEs in New Zealand adults and children with T1DM. METHODS: We approached adults and families of children with T1DM on insulin pumps in four main New Zealand centres. Participants completed a questionnaire examining pump-related issues they had experienced in the preceding 12 months. RESULTS: Response rate was 64 % with 174 of 270 eligible people participating in the study. 84 % of subjects reported one or more AEs, with an overall AE incidence of 3.42 per person/year (95 % CI 3.14, 3.73). An event serious enough to require a hospital presentation occurred in 9.8 %, all but one reporting high ketones or diabetic ketoacidosis (DKA). Set/site problems were the AE most commonly reported (by 53 % of respondents), followed by cutaneous complications (43 %) and pump malfunction (38 %). Few predictors of AEs (of any type) were found; however, a negative binomial regression model found that a longer duration of pumping (p = 0.018) and age <18 years (p = 0.043) were both associated with fewer AEs (all types combined). CONCLUSIONS:Insulin pump-associated AEs are very common. However, few variables are predictive of them with no relationships seen with glycaemic control, socio-economic status, pump manufacturer or infusion set type. Based on these findings, AEs should be anticipated in both adults and children, with anticipatory patient education and training recommended for their successful and safe use.
Authors: J Milburn; M de Lange; E Wiltshire; P Ross; J Rayns; P Tomlinson; F Wu; I M Kumarasamy; J Armishaw; Benjamin J Wheeler Journal: J Diabetes Metab Disord Date: 2019-03-05