Factors Related to Discontinuation of Continuous Subcutaneous Insulin-Infusion Therapy

To determine the factors related to discontinuation of continuous subcutaneous insulin-infusion (CSII) therapy in patients with insulin-dependent diabetes mellitus, we analyzed clinical data from a group of 177 patients followed for up to 5 yr. Fifty-one (29%) of the patients made a decision to terminate CSII during the study. Of the clinical characteristics present before the onset of treatment with an insulin pump, the most important variable to predict a future decision to terminate CSII was pregnancy, followed by female gender. In addition, there was a greater percentage of smokers, single or divorced patients, and patients with a history of treatment for mental illness in the dropout group, although none of these differences was statistically significant. There was no correlation between discontinuation of CSII and age, duration of diabetes, or prepump concentrations of HbA_1c. Events occurring during CSII were also analyzed for predictive value. Patients who discontinued CSII had a higher incidence of ketoacidosis and a lower incidence of hypoglycemic coma while using a pump. The most common reason reported by patients for terminating CSII therapy, cited by 24 (47%) of the 51, was discomfort, irritation, or infection at the infusion site.