Factors associated with withdrawal from insulin pump therapy: a large-population-based study.
Diabetes Metab Res Rev. 2020 Jan 10;:
Authors: Merzon E, Grossman J, Vinker S, Merhasin I, Levit S, Golan-Cohen A
AIM: To evaluate clinical, demographic, and socioeconomic factors associated with withdrawal from insulin pump (IP) therapy.
METHODS: We conducted a cross-sectional study using data from an Israeli health maintenance organization. All patients, 21 or more years old, with type 1(T1DM) or type 2 (T2DM) diabetes, who received IP therapy for a seven years period were identified. Patients who did not purchase IP maintenance supplies for at least six consecutive months were defined as withdrawn (N = 355). Patients who purchased supplies were defined as adherent (N = 352).
RESULTS: In both T1DM and T2DM patients, withdrawal from IP therapy was positively associated with a duration of diabetes longer than 5 years [OR = 13.26(CI 7.16; 23.34), P < 0.001)); and OR = 10.92(CI 5.64; 21.14), P < 0.001))respectively], non-adherence to dietician follow-up [OR = 5.78(CI 3.65; 9.14), P < 0.001)); and OR = 3.41(CI 1.99; 5.85)P < 0.001)) respectively], and poor glycemic control prior to IP treatment [OR = 4.04(CI 2.18; 7.48), P < 0.001) and OR = 4.59(CI 2.71; 7.81), P < 0.001)) respectively]. Co-morbid neuro-psychiatric disorders were also risk factors for IP withdrawal: diagnosis of depression [OR = 2.22(CI 1.16; 4.27) P = 0.017] and ADHD [OR = 2.45(CI 1.003; 5.087), P = 0.043)] among T1DM patients; and diagnosis of depression [OR = 1.85 (CI 1.05; 5.27), P = 0.046] and dementia [OR = 4.03(1.03; 19.77), P = 0.048] among T2DM patients.
CONCLUSION: In our large, real-world population-based study, we found that smoking, obesity, poor glycemic control, and co-morbid neuro-psychiatric disorders, were associated with a high rate of withdrawal from IP therapy. Healthcare providers ought to familiarize themselves with patient characteristics predictive of non-adherence and should intensify patient follow-up when incorporating this new, costly, and challenging technology. This article is protected by copyright. All rights reserved.
PMID: 31922314 [PubMed – as supplied by publisher]