First Libyan experience with insulin pump therapy: Impact on glycemic control and patients satisfaction

Background: The mainstay of contemporary management of type 1 diabetes mellitus (T1DM) is “physiological insulin replacement”. Regimens based on multiple daily injections (MDI) of insulin improve glycemic control and increase the frequency of hypoglycemia. Insulin pump therapy also improves glycemic control, and reduces the within-day and between-day glycemic variability that is seen with insulin injections. Objectives: We aimed to evaluate out first experience with insulin pump therapy by 1) assessing the glycemic control on insulin pump therapy compared to MDI based therapy and 2) to learn the attitude of patients and families towards the use of insulin pump. Patients and Methods: A prospective observational study involving 37 patients who used insulin pump between March & November 2013. Patients were selected according to certain criteria set up by treating physician. Data collected included demographic, clinical and biochemical data before, during and after insulin pump therapy use. Severe hypoglycemia requiring hospital management and diabetic ketoacidosis (DKA) were documented. Health-related quality of life, diabetes knowledge and patient's attitude towards pump therapy were captured before and after pump use. Outcome measures: Change HbA1c, occurrence of severe hypoglycemia and DKA. Change of body mass index (BMI) and difference in score results of health quality questionnaire. Results: 51.4% were males; mean age was 15 years (86.5% of them were between 2 and 22 years. About 94.4% had diabetes for a mean of 6.9 (range 1-14) years. The indications of insulin pump were high HbA1c (29.7%), wide variation of blood glucose (10.8%), severe hypoglycemia and/or hypoglycemic unawareness (18.9%), recurrent DKA (5.4%) and other indications (8.1%). However, 27.0% had a good metabolic control but multiple daily injections (MDI) was reportedly “compromising” their quality of life. The mean HbA1c level decreased from 9.1% to 7.4% (P = 0.001). The mean BMI increased from 21.2 to 22.0 kg/m2 (P=0.026) independent of age (r = 0.180, P = 0.295). Two episodes of DKA in one patient who had severe contact dermatitis at the site of cannula & sensor and one severe hypoglycemia, which required hospital admission due to unmatched carbohydrate intake to insulin dose due to incorrect carbohydrate counting. The health quality questionnaire scores revealed an improvement from 34.2 to 46.7 (P = 0.001). Conclusions: Our first experience with insulin pump therapy was positive in terms of achieving and maintaining good glycemic control in most of patients, it for more contact between patients and health providers and created better opportunities for diabetes education and support.