Effect of Insulin Pump Use on Diabetic Ketoacidosis in Type 1 Diabetes Mellitus: A Matched Cohort Study
Background: Diabetic ketoacidosis (DKA) is a well-known complication of diabetes mellitus with a significantly high mortality if not immediately and properly treated. Therefore, strategies for prevention of DKA are ever so important when managing diabetes mellitus, especially in the non-compliant pa...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2021-02-01
|
| Series: | Journal of Clinical Medicine |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2077-0383/10/5/898 |
| _version_ | 1797395345897947136 |
|---|---|
| author | Abbas Alshami Tiffany Purewal Steven Douedi Mohammed Alazzawi Mohammad A. Hossain Raquel Ong Shuvendu Sen Jennifer Cheng Swapnil Patel |
| author_facet | Abbas Alshami Tiffany Purewal Steven Douedi Mohammed Alazzawi Mohammad A. Hossain Raquel Ong Shuvendu Sen Jennifer Cheng Swapnil Patel |
| author_sort | Abbas Alshami |
| collection | DOAJ |
| description | Background: Diabetic ketoacidosis (DKA) is a well-known complication of diabetes mellitus with a significantly high mortality if not immediately and properly treated. Therefore, strategies for prevention of DKA are ever so important when managing diabetes mellitus, especially in the non-compliant patient population. Previously studies have suggested insulin pump use to carry an increased risk of DKA compared to insulin injections, while European studies suggest the opposite. We aimed to perform a retrospective cohort study to determine the risk of DKA in insulin pump versus injection in the United States. Methods: We utilized the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS) 2017 database, which represents a 20% sample of all payer hospitalizations in the United States. These hospitalizations were systematically selected by the Agency for Healthcare Resources and Quality (AHRQ) and we included all type 1 diabetes mellitus patients over the age of 18 who were on insulin, either pump or injections, in our study. Results: We found a total of 58,260 admissions for patients with type 1 DM. Of these, 7850 had insulin pump, 30,672 used insulin injection, and 19,738 had no prior insulin use. We found that insulin pump use, compared to injections, failed to predict a lower incidence of DKA in hospitalized patients. Conclusion: Although several studies from European countries have found a reduction of DKA risk with insulin pump use, in this study we found no clear significant difference in a United States-based study. While this may be possible due to different legislating and regulation organizations, further studies are warranted to further evaluate the benefit of either insulin dispensing modality. |
| first_indexed | 2024-03-09T00:33:09Z |
| format | Article |
| id | doaj.art-108617efcc7d48b2ad7adcf26bd0f7af |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T00:33:09Z |
| publishDate | 2021-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-108617efcc7d48b2ad7adcf26bd0f7af2023-12-11T18:20:44ZengMDPI AGJournal of Clinical Medicine2077-03832021-02-0110589810.3390/jcm10050898Effect of Insulin Pump Use on Diabetic Ketoacidosis in Type 1 Diabetes Mellitus: A Matched Cohort StudyAbbas Alshami0Tiffany Purewal1Steven Douedi2Mohammed Alazzawi3Mohammad A. Hossain4Raquel Ong5Shuvendu Sen6Jennifer Cheng7Swapnil Patel8Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, USADepartment of Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, USADepartment of Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, USADepartment of Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, USADepartment of Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, USADivision of Endocrinology, Diabetes, and Metabolism, Jersey Shore University Medical Center, Neptune, NJ 07753, USADepartment of Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, USADivision of Endocrinology, Diabetes, and Metabolism, Jersey Shore University Medical Center, Neptune, NJ 07753, USADepartment of Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, USABackground: Diabetic ketoacidosis (DKA) is a well-known complication of diabetes mellitus with a significantly high mortality if not immediately and properly treated. Therefore, strategies for prevention of DKA are ever so important when managing diabetes mellitus, especially in the non-compliant patient population. Previously studies have suggested insulin pump use to carry an increased risk of DKA compared to insulin injections, while European studies suggest the opposite. We aimed to perform a retrospective cohort study to determine the risk of DKA in insulin pump versus injection in the United States. Methods: We utilized the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS) 2017 database, which represents a 20% sample of all payer hospitalizations in the United States. These hospitalizations were systematically selected by the Agency for Healthcare Resources and Quality (AHRQ) and we included all type 1 diabetes mellitus patients over the age of 18 who were on insulin, either pump or injections, in our study. Results: We found a total of 58,260 admissions for patients with type 1 DM. Of these, 7850 had insulin pump, 30,672 used insulin injection, and 19,738 had no prior insulin use. We found that insulin pump use, compared to injections, failed to predict a lower incidence of DKA in hospitalized patients. Conclusion: Although several studies from European countries have found a reduction of DKA risk with insulin pump use, in this study we found no clear significant difference in a United States-based study. While this may be possible due to different legislating and regulation organizations, further studies are warranted to further evaluate the benefit of either insulin dispensing modality.https://www.mdpi.com/2077-0383/10/5/898diabetic ketoacidosisdiabetes mellitusinsulinpumpinjection |
| spellingShingle | Abbas Alshami Tiffany Purewal Steven Douedi Mohammed Alazzawi Mohammad A. Hossain Raquel Ong Shuvendu Sen Jennifer Cheng Swapnil Patel Effect of Insulin Pump Use on Diabetic Ketoacidosis in Type 1 Diabetes Mellitus: A Matched Cohort Study Journal of Clinical Medicine diabetic ketoacidosis diabetes mellitus insulin pump injection |
| title | Effect of Insulin Pump Use on Diabetic Ketoacidosis in Type 1 Diabetes Mellitus: A Matched Cohort Study |
| title_full | Effect of Insulin Pump Use on Diabetic Ketoacidosis in Type 1 Diabetes Mellitus: A Matched Cohort Study |
| title_fullStr | Effect of Insulin Pump Use on Diabetic Ketoacidosis in Type 1 Diabetes Mellitus: A Matched Cohort Study |
| title_full_unstemmed | Effect of Insulin Pump Use on Diabetic Ketoacidosis in Type 1 Diabetes Mellitus: A Matched Cohort Study |
| title_short | Effect of Insulin Pump Use on Diabetic Ketoacidosis in Type 1 Diabetes Mellitus: A Matched Cohort Study |
| title_sort | effect of insulin pump use on diabetic ketoacidosis in type 1 diabetes mellitus a matched cohort study |
| topic | diabetic ketoacidosis diabetes mellitus insulin pump injection |
| url | https://www.mdpi.com/2077-0383/10/5/898 |
| work_keys_str_mv | AT abbasalshami effectofinsulinpumpuseondiabeticketoacidosisintype1diabetesmellitusamatchedcohortstudy AT tiffanypurewal effectofinsulinpumpuseondiabeticketoacidosisintype1diabetesmellitusamatchedcohortstudy AT stevendouedi effectofinsulinpumpuseondiabeticketoacidosisintype1diabetesmellitusamatchedcohortstudy AT mohammedalazzawi effectofinsulinpumpuseondiabeticketoacidosisintype1diabetesmellitusamatchedcohortstudy AT mohammadahossain effectofinsulinpumpuseondiabeticketoacidosisintype1diabetesmellitusamatchedcohortstudy AT raquelong effectofinsulinpumpuseondiabeticketoacidosisintype1diabetesmellitusamatchedcohortstudy AT shuvendusen effectofinsulinpumpuseondiabeticketoacidosisintype1diabetesmellitusamatchedcohortstudy AT jennifercheng effectofinsulinpumpuseondiabeticketoacidosisintype1diabetesmellitusamatchedcohortstudy AT swapnilpatel effectofinsulinpumpuseondiabeticketoacidosisintype1diabetesmellitusamatchedcohortstudy |