Surveillance in Florida of Continuous Subcutaneous Insulin Infusion Use in Cohort

Because of concerns about safety and expense associated with continuous subcutaneous insulin infusion (CSII), all people who had used CSII as of July 1982 were identified. Annual follow-up has resulted in data for up to 61 mo. Of the 92 nonpregnant registrees, 31 were <20 yr old, 36 were 20–29, and 25 were 30 yr or older. Two deaths occurred in 1780 person-months of pump use. The cumulative proportion on the pump (CPOP) or actuarial CSII continuance proportion was 11%. There was no significant difference between sexes or between ages for men, but despite eliminating pregnant women, those ≥30 yr old had a CPOP of 0.22, compared with 0.11 for those <30 yr (P = .03). Continuance curves were no different for those beginning CSII with or without complications or for those with or without good glucose control. Those who began at patient request did have better CPOP than thoe who began at physician request (P = .05). Physician perception of clinical, mechanical, or psychosocial problems while on the pump was not predictor of continuance curves as measured by CPOP. Of the 17 physicians queried at the latest update, 9 physicians have 16 current CSII users; these 9 have only 14% of their patients in the original cohort currently on CSII. This is compared with the 3 physicians who have 34 current users and 60% of their original cohort on CSII. Four physicians no longer use CSII. Devices for CSII cost $131/person-month of use. For those discontinuing use within 3 mo of initiation of CSII, per person-month cost is $1517. These population-based data provide further information for use in deciding whether to use CSII as a therapeutic option.