{'fraction_non_alphanumeric': 0.031746031746031744, 'fraction_numerical': 0.025252525252525252, 'mean_word_length': 4.74120082815735, 'pattern_counts': {'":': 0, '<': 2, '<?xml version=': 0, '>': 2, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Is Pump Therapy for All with Type 1 Diabetes?

Starting with very cumbersome devices in the 1960s, continuous subcutaneous insulin infusion (CSII) technology slowly evolved until the DCCT’s demonstration of the link between improved glycemic control and a decrease in diabetes-related complications spurred insulin pump development. Current insulin infusion pumps provide a broad array of features to modulate insulin therapy. Adaption of CSII has subsequently grown over the years. Although there is significant variation in the uptake of CSII therapy across the world, the T1D Exchange survey of *16,000 subjects from 67 U.S.-based pediatric and adult endocrinology practices reports that pump use does not vary much by age, averaging 60% from 2 to 50 years of age. In the current issue, Boulet et al. report on the prevalence of insulin pump use in a very interesting group of 305 Canadian patients whose duration of type 1 diabetes is >50 years. Data were collected using a detailed mailed questionnaire. Forty-four percent of the respondents reported using a pump for a median of 8 years. Twenty of the 133 pump users had been using a pump for more than 20 years. Pump users were slightly younger and better educated than the nonpump group. Although only a few of the subjects habitually used continuous glucose monitoring (CGM), rates were higher among the pump group, 11% versus 5%. Although minor hypoglycemia events (self-monitoring of blood glucose (SMBG) <4 mmol/L) occurred significantly more often among the pump users (5.1 vs. 6.5 events per month), severe hypoglycemia was significantly reduced among the pump users (1.3 vs. 0.5 events in the past year). Habitual CGM use was likewise associated with a substantially lower rate of severe hypoglycemia. The mean HbA1cs were not statistically different; 7.4% in the pump group versus 7.6% in the nonpump group. In multivariate analysis, only the daily frequency glucose tests and rate of minor hypoglycemia were associated with a lower HbA1c. Intriguingly, each incremental daily SMBG was associated with a 0.12% decrease in HbA1c. On the other end of the age spectrum, Campbell et al. used T1D Exchange data to compare 2684 children and adolescents in poor control (HbA1c > 8.9%) with 588 in excellent control (HbA1c < 7%). They found a multitude of patient characteristics and diabetes management practices were associated with membership in the excellent control group. As an example, adjusting for other factors, those who never missed an insulin bolus, compared with those who missed three or more boluses weekly, were 24.5 times more likely to be in the excellent control group. Similarly adjusted, a parallel analysis showed that those using pumps were 3.1 times more likely to be in excellent control.