Vojtech Cesak, Hedvika Cesakova, Jitka Brozova, Zdenek Jankovec, Zdenek Rusavy and Martin Matejovic
Introduction: Insulin pump therapy presents an increasingly used method. Its usage has been steadily increasing within last 40 years and number of studies concerning the insulin pump therapy commencement and various aspects arising in course of the treatment, was presented. But only few studies dealing with the patients after insulin pump treatment termination exist. Furthermore, the majority of these studies are focused on pediatric population. Objectives: to determine, whether the glycemic control changes after insulin pump termination regardless of the type of diabetes or method of treatment withdrawn (pump withdrawn by a physician vs. patient’s wish). To evaluate whether the glycemic control after insulin pump termination differs in type 1 and type 2 diabetic patients and if there are any changes after insulin pump termination due to the method of treatment withdrawn (pump withdrawn by a physician vs. patient’s wish). Methods: The CSII treatment was terminated to a total of 228 patients in 2001 - 2012. 74 patients had sufficient data to analyze four variables: HbA1c, weight, total daily bolus insulin dose, and total daily basal insulin dose. The initial values was derived from data 3-6 months before the treatment withdrawal, other data were collected at time of withdrawal, and at 3, 6, 12 and 24 months following the CSII treatment termination. Total length of follow-up was 2.5 years. Results: There was no significant change in HbA1c: it was 78.5 mmol/mol (interquartil range 69; 95) at time of insulin pump treatment (specifically in the last half year prior to treatment withdrawal) and 81 mmol/mol (68; 93) at time of treatment termination (p=0,365). The median of weight was 81 kg (interquartil range 67; 95) 3-6 months prior to treatment termination and 80 kg (interquartil range 66,8; 97) at time of withdrawal. These changes are also nonsignificant (p=0,963). The only significant change observed was the increase in the total daily bolus insulin dose after the treatment termination - median at time of termination 20 IU/day and after withdrawal 30 IU/day (p=0,001). The dose of basal insulin was not significant (p=0,619). The evaluation of subgroups (type 1 diabetes versus type 2 diabetes and pump withdrawn by a physician versus patient’s wish group) was the same results - e.g. the only significant change was in the dose of bolus insulin. Conclusions: In our study, we were not able to demonstrate any impact of insulin pump treatment termination on the further development of glycemic control of the patients.