and 3 other(s)
The effectiveness of Continuous Subcutaneous Insulin Infusion (CSII) is debated. Several studies indicate that improvements in glycaemic control or QoL strongly depend on psychological, educational and motivational factors. We analysed decisions and reasons for discontinuation of pump use in children and youth with T1D. In a single center retrospective cross-sectional study (Diabeter, currently 62% CSII-use), clinical data between 2007 and 2018 were extracted from EHRs of patients aged 0-25 years. Patient discontinuation reasons (practical, emotional and clinical/technical) were assessed by questionnaire. CSII was discontinued by 198 patients (53.8% female). Age at diagnosis, pump initiation and discontinuation was 8.3 (5.2), 12.8 (6.8) and 16.2 (6.0) years (mean±SD), respectively. Key discontinuation reasons reported (19% response rate): dissatisfaction with CSII (device influencing body image, 66%; increased confrontation with T1D, 58%). Clinical factors were mostly advised by diabetes team members: low daily insulin dose (skipping insulin boluses), minimal glucose measurements (leading to worse glycaemic control), and skin infections/irritations (58%). Of 85 of 198 patients with HbA1c data available before (HbA1c 9.8%) and 3-6 months post-discontinuation, 54% showed improved HbA1c (-1.7%) post-discontinuation: 34%/12% showed no change or increased HbA1c (+1.1%: here factors other than insulin delivery likely play a determining role). Although CSII is generally associated with improved glycaemic control and QoL, our data identify a subgroup with worsening glycaemic control reporting negative experiences. Using an approach including a realistic evaluation of patients’ expectations and preferences, we aim to timely identify patients at risk for unsuccessful CSII and to provide appropriate training and education before and during CSII.
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