Associations between Insulin Pump Self-Management and HbA1c

Background and Aims: It is well-known that diabetes self-management is important for glycemic outcome, also among insulin pump users. We aimed to explore which factors were independently associated with HbA1c.

Methods: Adult insulin pump users (18+) with type 1 diabetes from the Capital Region of Denmark completed an online questionnaire covering aspects of insulin pump self-management. HbA1c and demographics were collected from medical records and national registries. Backward selected linear regression models were used to investigate associations between HbA1c and each aspect of self-management, adjusted for one another, CGM/isCGM, sex, age, marital status and educational level.

Results: In total, 770 individuals responded; 60% were female, median age was 49 (p25-p75: 36-60) and ranged from 18-86 years, median HbA1c was 56mmol/mol (p25-p75: 50-62) and ranged from 25-135, and 93% used bolus calculator for meal bolus and/or correction. Self-adjustment of pump settings showed the strongest association with lower HbA1c. Avoiding missed boluses, timing of bolus insulin before meals, and timely infusion set change were also associated with a lower HbA1c. No statistically significant associations were found for HbA1c and use of advanced pump features.

Conclusion: Self-adjusting insulin pump settings, low frequency of missed meal boluses, optimal timing of meal bolus and timely change of infusion set are associated with lower HbA1c.