A recent multinational collaboration found that the percentage of children over the age of 6 years living with type 1 diabetes (T1D) who use insulin pumps is higher in the US than in England, Wales, Germany, and Austria, and in all of these countries, HbA1c levels were lower among pump users.
In this collaboration, investigators from the T1D Exchange (US), the UK National Paediatric Diabetes Audit (England/Wales) and the DPV initiative (Austria/Germany) pooled their data from T1D patients under the age of 18 years. Researchers compared the proportion of patients who had used an insulin pump at any time during a two-year period from 2011 to 2012 to those using injections; HbA1c levels also were examined.
“From a European perspective, most families with young children with diabetes report a much better quality of life after switching to insulin pumps and spread this personal preference among patient support groups. Additional factors are frequent needle phobia, irregular eating habits, and frequent viral infections in this age group. Pumps are reimbursed by statutory or private health insurance in practically all patients in this age group in Austria and Germany. In England and Wales insulin pumps are funded by the National Health Service. In contract, in the US, insulin pumps are primarily appealing to adolescents, an age-group highly interested in electronic devices,” said Dr. Reinhard Holl, Director of the Prospective Diabetes Follow-up Registry (DPV) and Dr. Justin Warner, Director of the National Paediatric Diabetes Audit (NPDA), “Whilst type 1 diabetes and the available technologies do not differ on either side of the Atlantic, the attitudes of patients and their families, doctors, and other healthcare professionals as well as health insurance companies and other providers differ. Although these are equally developed countries they have variable beliefs and restraints about how to best manage their patients, resulting in markedly diverse use of technology among the countries.”
Overall, pump use was highest in the United States, at 47%. Austria and Germany were next in frequency of use, at 40% and 41% respectively, followed by Wales and England showing the lowest figures at just 16% and 14%. In the US, frequency of pump use increased with age, but in other nations, there was a downward trend.
In all countries, the use of insulin pumps was higher among patients with longer T1D duration. Overall, those using pumps had a lower HbA1c level (average 8.1) than those using injections (average 8.6). Average HbA1c was lowest in Germany and Austria and higher in England and Wales.
The results of this study were recently presented by David Maahs, MD, PhD, at the International Society for Pediatric and Adolescent Diabetes (ISPAD) conference in Toronto, Canada.
“Advances in technology have improved the management of type 1 diabetes for children and their families” said Maahs, “but, there is still considerable variation between countries in the number of patients using insulin pumps. Large registries allow us to compare clinical practice and outcomes to be able to target efforts to improve care for people with type 1 diabetes.”
Data for this study included a sample of 13,966 pediatric T1D patients from 57 endocrinology practices in the United States; 14,539 patients from 177 diabetes units in England and Wales; and 26,262 patients from 209 pediatric centers in Germany and Austria. HbA1c levels were collected from clinical records.
This collaboration was conducted by David M. Maahs, Julia Hermann, Nicole Foster, Sabine Hofer, William Tamborlane, Thomas Kapellen, Roy Beck, Reinhard Holl, and Justin Warner for T1D Exchange, DPV, and National Paediatric Diabetes Audit and the Royal College of Paediatrics and Child Health registries.
About T1D Exchange
T1D Exchange, the first program of Unitio, was founded on the premise that finding faster, better therapies for type 1 diabetes (T1D) requires a research model as multi-faceted as the disease itself. T1D Exchange acts as a convener of the thousands of people working to improve patient outcomes already—by connecting them to one another and to the patient community at large. Drawing on decades of research and data that have come before, T1D Exchange aims to be the translational engine that enables the entire T1D ecosystem to collaborate in truly novel ways via the integration of a Clinic Network, Clinic Registry, Biobank, and the online patient/caregiver community, Glu.
About DPV and NPDA
The German and Austrian DPV registry and English and Welsh NPDA were established with an objective of improving the care of children with type 1 diabetes through sharing of best practices and the collection of clinical outcome data in large numbers of patients. The DPV is supported through the German BMBF competence network diabetes mellitus. The NPDA is supported through the Healthcare Quality Improvement Partnership and conducted by the Royal College of Paediatric and Child Health.