Poster Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2014

 A pilot study of factors associated with better glycaemic control in insulin pump therapy (#332)

Wanling Wen 1 , Ruth Frampton 2 , Kristine Wright 3 , Stephanie Fottore 3 , Bruce Shadbolt 4 , Sumathy Perampalam 5
  1. Department of Endocrinology, Eastern Health, Ringwood East, VIC, Australia
  2. Canberra hospital, ACT health, Canberra, ACT, Australia
  3. ACT Health Diabetes Service, Canberra hospital, Canberra, ACT, Australia
  4. Canberra hospital, ACT health, Canberra, ACT, Australia
  5. Department of Endocrinology, Canberra hospital, ACT health, Canberra, ACT, Australia

The purpose of this pilot study was to determine the factors related to knowledge and behaviour that are associated with better glycaemic control among type 1 diabetes adults on insulin pump therapy (IPT).   A combination of a questionnaire and insulin pump download data were used.

It was a cross-sectional study undertaken between December 2013 and May 2014. Fifty one adults on IPT were recruited through the endocrinology clinics at the Canberra hospital.  The mean age (±SD) was 35.8 ± 14.2 years, diabetes duration 18.8 ± 12.4 years, IPT duration 6.2 ± 3 years, HbA1c 8 ± 1%, and male-to-female ratio 23:27.  

On univariate analysis, participants who have changed their insulin pump setting when indicated had a significantly better HbA1c than those who haven’t done so (p = 0.04). Participants who checked their blood glucose level more often, or used the correct carbohydrate counting methods, or gave themselves correctional insulin more often, or analysed their insulin pump data regularly, tended to have a better HbA1c but not to a statistically significant degree (p > 0.05).

Better IPT related behaviour contributed significantly to a better HbA1c (=< 8%) based on a logistic regression model (χ2 = 25.24, p < 0.001) after adjusting for age, gender, length of diabetes and duration of IPT.  The model was able to correctly classify 90% of those who had a good HbA1c (=<8%) and 75% of those did not, for an overall success rate of 85% (Table 1). Interestingly better IPT related knowledge did not contribute positively to a better HbA1c in the model.

The current study has identified key knowledge and behaviour factors associated with better glycaemic control.  This information may help to define the key educational components in the management of IPT users.

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  1. Pickup JC. Insulin-pump therapy for type 1 diabetes mellitus.N Engl J Med 2012; 366 (17): 1616-24.
  2. Jayasekara RS, Munn Z, Lockwood C. Effect of educational components and strategies associated with insulin pump therapy: a systemic review. Int J Evid Based Healthc 2011; 9: 346-61.
  3. Grant L, Lawton J, Hopkins D, Elliott J, Lucas S, Clark M, MacLellan I, Davies M, Heller S, Cooke D. Type 1 diabetes structured education: What are the core self-management behaviours? Diabet Med. 2013 Jun;30(6):724-30.