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Introduction
Data from the Swedish National Diabetes Register (NDR) indicate that in Sweden in 2013, there were approximately 36,000 people with type 1 diabetes being treated in specialist clinics [1], of whom an estimated 21% were using insulin pumps [continuous subcutaneous insulin infusion (CSII)]. Notably, the proportion of adults using CSII was reported to vary considerably with age, with CSII use being more common in younger and in female patients [1].
CSII represents an important treatment option for type 1 diabetes patients and is a particularly valuable alternative for several subgroups of patients, including those who cannot achieve good glycemic control with multiple daily injections (MDI) of insulin, patients with frequent or severe hypoglycemic events and young children with a fear of needles. There are also several other potential reasons why CSII may be preferable, such as erratic lifestyles with irregular shiftwork or travel across time zones that may complicate disease management. Indeed, in a study of routine clinical practice by Jendle et al. the most common indications for CSII were glucose excursions (35.8%), elevated glycated hemogloblin (HbA1c; 33.0%), patient preference (11.5%), frequent hypoglycemic events (7.9%) and facilitation of glycemic control (6.4%) [2]. Many patients may also prefer CSII to MDI, with patient satisfaction having been reported to be significantly higher in patients using CSII than in those receiving MDI [3].
In terms of clinical benefits, CSII has been shown to improve glycemic control and reduce the incidence of severe hypoglycemic events relative to MDI, particularly in patients with very poor baseline glycemic control [4, 5, 6–7]. Data from the Swedish NDR has also shown that CSII is associated with a significantly lower hazard ratio for fatal coronary heart disease, fatal cardiovascular disease and all-cause mortality relative to MDI [8].
Sensor-augmented pump therapy (SAP) combines real time continuous glucose monitoring (CGM) with CSII and provides additional benefits beyond those provided by CSII alone. Studies conducted to date have shown that SAP is associated with improved glycemic control and a reduced frequency of hypoglycemic events compared with CSII [9, 10–11]. Moreover, SAP-related technology is continually evolving, and SAP with automated insulin suspension includes devices incorporating features such as low glucose suspend (LGS) or predictive low glucose suspend (SmartGuard™ technology), both of which are features designed to...