A pilot study of factors associated with glycaemic control in adults with Type 1 diabetes mellitus on insulin pump therapy

Aims: To identify the knowledge and management factors associated with glycaemic control among adults with Type 1 diabetes mellitus treated with insulin pump therapy. Methods: A cross-sectional study of adults with Type 1 diabetes mellitus on insulin pump therapy for at least 12 months (n = 50, 18-70 years old) was undertaken between December 2013 and May 2014. A new questionnaire was developed to evaluate participants' knowledge and management related to insulin pump therapy, and were correlated with insulin pump data, HbA_1c and frequency of hypoglycaemia. Results: Participants who changed their insulin pump settings when indicated had significantly better glycaemic control than those who did not (P = 0.04). Multivariate logistic regression analysis found that better overall insulin pump therapy management was a significant predictor of better glycaemic control (odds ratio 4.45, 95% confidence interval 1.61-12.3; P = 0.004) after adjusting for potential confounders including age, gender, duration of diabetes and insulin pump therapy. However, overall insulin pump therapy knowledge was not a significant predictor of glycaemic control (P = 0.058). There was no significant association between frequency of hypoglycaemia and insulin pump therapy knowledge or management. Conclusions: We identified some key knowledge and management factors associated with glycaemic control in adults with Type 1 diabetes mellitus on insulin pump therapy using a newly designed questionnaire. The pilot study assessed the clinical utility of this evaluation tool, which may facilitate provision of targeted education to insulin pump therapy users to achieve optimal glycaemic control. What's new?: At present, there is no consensus on what constitutes the important aspects of knowledge and management relevant to adults with Type 1 diabetes mellitus on insulin pump therapy (IPT). Using a newly designed questionnaire as an evaluation tool, we identified the knowledge and management factors associated with glycaemic control in adult IPT users and also assessed the questionnaire for its clinical utility. The importance of encouraging flexible application of IPT in diabetes education has been demonstrated. Periodic assessment of IPT users using a standardized evaluation tool may facilitate targeted education to achieve optimal glycaemic control.