Change in HbA1c among filipino diabetic patients who shifted from multiple daily injection to continuous subcutaneous insulin infusion: A retrospective cohort study

ABSTRACT

Introduction@#Insulin delivered by multiple daily injection (MDI), for a time, has been considered to be the most physiologic among the different insulin regimen. Among patients on MDI, there is still a significant proportion who remains uncontrolled. Continuous subcutaneous insulin infusion (CSII) or insulin pump has been shown to benefit some patients who are still uncontrolled despite intensive insulin therapy with MDI. Currently, there is little information on the use of insulin pump in the Philippines. The researchers aim to determine the change in HbA1c and the proportion of patients with HbA1c of <8% after shifting from MDI to CSII. To correlate the change in HbA1c with age and baseline HbA1c. To compare the change in HbA1c between gender, type of diabetes and type of bolus regimen.@*Methods@#This is a retrospective cohort analytical study of 33 adult patients with type 1 or type 2 diabetes mellitus (DM), switched from MDI to insulin pump. Chart review was done to obtain data on age, gender, type of bolus, baseline HbA1c and HbA1c six to twelve months after switching insulin pump initiation. The change in HbA1c was correlated with baseline HbA1c and age. Mean change in HbA1c was also compared between gender, type of bolus and type of diabetes.@*Results@#Mean HbA1c prior to switching to insulin pump was 10±1.7. The HbA1c reduction was 1.86±1.6 (p<0.001, CI 1.38-2.34), resulting to a mean final A1c of 8.1±1.2 after CSII initiation. Seventeen out of 33 patients (52%) achieved an average HBA1c of <8%. A positive correlation was observed between HBA1c reduction and baseline HbA1c (r =0.738, p<0.001) but not with age (r = -0.002, p=0.99). There was no significant difference in the HbA1c reduction between male and female (p=0.353), Type 1 DM and Type 2 DM (p=0.133), and those that used fixed bolus vs bolus calculator (p=0.559). The reduction in A1c remains significant when analyzed as individual subgroups 2.1±2.3 (p=0.001) in males; 1.6±1.0 (p<0.001) in females; 1.5±1.6 (p=0.001) in type 1; 2.3±1.6 (p<0.001) in type 2; 2.1±1.5 (p<0.001) in bolus calculator, and 1.7±1.8 (p<0.001) in fixed bolus group.@*Conclusion@#There is significant reduction in HbA1c among this cohort of Filipino diabetic patients after switching from MDI to CSII. While majority of patients had >1% reduction, achieving an ideal goal of <7% remains to be a challenge. Greater HbA1c reduction are seen in patients with higher baseline HbA1c. There is no significant difference in the reduction in HbA1c with respect to gender, type of diabetes and type of bolus used.