Differences in Glycemic Control for Inpatients with Type 1 Diabetes on Insulin Pump Versus Subcutaneous Insulin Therapy

Yuting Ye; Bernardo A Acevedo-Mendez; Stephanie Izard; Alyson K Myers

doi:10.1007/s11606-024-08736-4

Differences in Glycemic Control for Inpatients with Type 1 Diabetes on Insulin Pump Versus Subcutaneous Insulin Therapy

J Gen Intern Med. 2024 Apr 8. doi: 10.1007/s11606-024-08736-4. Online ahead of print.

Authors

Yuting Ye^{1

2}, Bernardo A Acevedo-Mendez^{3

4}, Stephanie Izard⁵, Alyson K Myers^{4

6

7}

Affiliations

¹ Department of Medicine, North Shore University Hospital, Northwell Health, Manhasset, NY, USA. yye2@northwell.edu.
² Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, North Shore University Hospital, 300 Community Drive, Manhasset, NY, 11030, USA. yye2@northwell.edu.
³ Department of Medicine, North Shore University Hospital, Northwell Health, Manhasset, NY, USA.
⁴ Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, North Shore University Hospital, 300 Community Drive, Manhasset, NY, 11030, USA.
⁵ Quantitative Intelligence, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.
⁶ Division of Endocrinology, Department of Medicine, Montefiore Einstein, Bronx, NY, USA.
⁷ Albert Einstein College of Medicine, Bronx, NY, USA.

PMID: 38587726
DOI: 10.1007/s11606-024-08736-4

Abstract

Background: Inpatient use of insulin pump therapy has been increasing due to greater availability of this technology, however there is a paucity of research that investigates glycemic control of inpatient insulin pump users.

Objective: To compare the glycemic control of hospitalized patients with type 1 diabetes (T1D) who used insulin pump vs. multiple daily injections (MDI).

Design: Retrospective chart review.

Participants: Patients with T1D who were hospitalized between January 1, 2017, and December 31, 2019, in an academic medical center in the New York metropolitan area.

Main measures: Patients were categorized into three groups based on their method of insulin administration: "pump only" group used insulin pump exclusively, "MDI only" group used MDI only, and "intermittent pump" group used a combination of both methods. The primary endpoints are mean blood glucose, rates of hypoglycemic events (blood glucose < 70 mg/dL), and rates of hyperglycemic events (blood glucose > 250 mg/dL). Separate multivariable Poisson regressions were performed to determine the association between the type of insulin administration and rate outcomes (i.e., rate of hypoglycemic events and rate of hyperglycemic events).

Results: The study included 78 patients with a mean age of 51, who were mostly male (54%), and white (72%). The average proportion of glucose measurements that were hyperglycemic for the "pump only", "MDI only", and "intermittent pump" groups were 0.11 (SD = 0.11), 0.25 (SD = 0.19), and 0.24 (SD = 0.25), respectively. The "pump only" group has a significantly lower proportion of hyperglycemic events as compared to the "MDI only" group (p = 0.0227).

Conclusions: In this sample, patients who exclusively used their insulin pump while inpatient had a lower rate of hyperglycemic events than patients who used MDI only; suggesting that select patients can safely continue their insulin pump therapy in the inpatient setting.

Keywords: hospitalization; inpatient; insulin pump; multiple daily injections; type 1diabetes..