Background: Insulin pumps are increasingly being used as a method of insulin delivery in patients with type 1 diabetes mellitus (T1DM). Diabetic ketoacidosis (DKA) is a serious complication of T1DM. This study aims to identify causes of DKA in T1DM patients on insulin pump, and to compare these with patients with T1DM on multiple daily insulin injections (MDII).
Methods: This was a prospective observational pilot study assessing DKA between 2 groups of patients with T1DM: (1) on insulin pump and (2) on MDII. Demographic and clinical data were obtained from chart review. Patients’ knowledge on insulin and diabetes care was assessed with a questionnaire we devised.
Results: We enrolled 17 adult patients - 12 on insulin pump (7 Medtronic, 3 Tandem, 2 Animas) and 5 on MDII - who were admitted to the ICU for DKA management. Eleven (65%) were females, all were Caucasian, with median age in pump users 27.0 years (IQR 22.5,39.5) vs. MDII 38.0 (IQR 32.0,51.0)(p=0.045). The rest of the demographic data were comparable. Majority of the patients on insulin pump had a pump >5 years and had the current pump <5 years. Six were given pump training in the physician’s office and 6 by the insulin pump company. In patients on insulin pump, 41% of DKA cases were pump- and tubing- related, 41% were due to non-adherence and 18% were due to an infection. In contrast, all the MDII patients had DKA due to non-adherence. Insulin pump patients had significantly higher adherence (p= 0.014) and better knowledge of managing hyperglycemia on sick days (p = 0.029) than MDII patients.
Conclusion: A significant proportion of DKA in pump users was due to pump issues. Non-adherence was common in both pump users and MDII. Continued education on pump use may reduce the rate of DKA in pump users.
M. Amir: None. S. Al Ashi: None. M. Lansang: None. M. Al-Jaghbeer: None.