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<h5 class="section-title" id="d13198820e403">Question</h5>
<p id="d13198820e405">Are the rates of severe hypoglycemia and diabetic ketoacidosis
lower with insulin
pump therapy than with insulin injection therapy in young patients with type 1 diabetes?
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<h5 class="section-title" id="d13198820e408">Findings</h5>
<p id="d13198820e410">In this population-based observational study including 30 579
young patients with
type 1 diabetes, pump therapy, compared with injection therapy, was associated with
significantly lower rates of severe hypoglycemia (9.55 vs 13.97 per 100 patient-years)
and ketoacidosis (3.64 vs 4.26 per 100 patient-years), and with lower hemoglobin A
<sub>1c</sub> levels (8.04% vs 8.22%) in a propensity score–matched cohort.
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<h5 class="section-title" id="d13198820e416">Meaning</h5>
<p id="d13198820e418">Insulin pump therapy was associated with reduced risks of short-term
diabetes complications
and with better glycemic control compared with injection therapy.
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<h5 class="section-title" id="d13198820e423">Importance</h5>
<p id="d13198820e425">Insulin pump therapy may improve metabolic control in young
patients with type 1 diabetes,
but the association with short-term diabetes complications is unclear.
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<h5 class="section-title" id="d13198820e428">Objective</h5>
<p id="d13198820e430">To determine whether rates of severe hypoglycemia and diabetic
ketoacidosis are lower
with insulin pump therapy compared with insulin injection therapy in children, adolescents,
and young adults with type 1 diabetes.
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<h5 class="section-title" id="d13198820e433">Design, Setting, and Participants</h5>
<p id="d13198820e435">Population-based cohort study conducted between January 2011
and December 2015 in
446 diabetes centers participating in the Diabetes Prospective Follow-up Initiative
in Germany, Austria, and Luxembourg. Patients with type 1 diabetes younger than 20
years and diabetes duration of more than 1 year were identified. Propensity score
matching and inverse probability of treatment weighting analyses with age, sex, diabetes
duration, migration background (defined as place of birth outside of Germany or Austria),
body mass index, and glycated hemoglobin as covariates were used to account for relevant
confounders.
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<h5 class="section-title" id="d13198820e438">Exposures</h5>
<p id="d13198820e440">Type 1 diabetes treated with insulin pump therapy or with multiple
(≥4) daily insulin
injections.
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<h5 class="section-title" id="d13198820e443">Main Outcomes and Measures</h5>
<p id="d13198820e445">Primary outcomes were rates of severe hypoglycemia and diabetic
ketoacidosis during
the most recent treatment year. Secondary outcomes included glycated hemoglobin levels,
insulin dose, and body mass index.
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<h5 class="section-title" id="d13198820e448">Results</h5>
<p id="d13198820e450">Of 30 579 patients (mean age, 14.1 years [SD, 4.0]; 53% male),
14 119 used pump therapy
(median duration, 3.7 years) and 16 460 used insulin injections (median duration,
3.6 years). Patients using pump therapy (n = 9814) were matched with 9814 patients
using injection therapy. Pump therapy, compared with injection therapy, was associated
with lower rates of severe hypoglycemia (9.55 vs 13.97 per 100 patient-years; difference,
−4.42 [95% CI, −6.15 to −2.69];
<i>P</i> < .001) and diabetic ketoacidosis (3.64 vs 4.26 per 100 patient-years;
difference,
−0.63 [95% CI, −1.24 to −0.02];
<i>P</i> = .04). Glycated hemoglobin levels were lower with pump therapy than with
injection
therapy (8.04% vs 8.22%; difference, −0.18 [95% CI, −0.22 to −0.13],
<i>P</i> < .001). Total daily insulin doses were lower for pump therapy compared
with injection
therapy (0.84 U/kg vs 0.98 U/kg; difference, −0.14 [−0.15 to −0.13],
<i>P</i> < .001). There was no significant difference in body mass index between
both treatment
regimens. Similar results were obtained after propensity score inverse probability
of treatment weighting analyses in the entire cohort.
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<h5 class="section-title" id="d13198820e465">Conclusions and Relevance</h5>
<p id="d13198820e467">Among young patients with type 1 diabetes, insulin pump therapy,
compared with insulin
injection therapy, was associated with lower risks of severe hypoglycemia and diabetic
ketoacidosis and with better glycemic control during the most recent year of therapy.
These findings provide evidence for improved clinical outcomes associated with insulin
pump therapy compared with injection therapy in children, adolescents, and young adults
with type 1 diabetes.
</p>
</div><p class="first" id="d13198820e470">This population-based cohort study compares
rates of severe hypoglycemia and diabetic
ketoacidosis among children, adolescents, and young adults with type 1 diabetes managed
with insulin pump therapy vs insulin injection therapy.
</p>