Monitoring of diabetes compensation in patients treated with an insulin pump in the Czech Republic

Česká verzia

Authors: Zdeněk Rušavý ¹; Petr Honěk ²; Ladislav Dušek ^3,4; Tomáš Pavlík ^3,4; Denisa Janíčková-Žďárská ⁵; Milan Kvapil ⁵
Authors place of work: Interní klinika FN a LF UK Plzeň, přednosta prof. MUDr. Martin Matějovič, Ph. D. ¹; Všeobecná zdravotní pojišťovna České republiky, Praha, ředitel Ing. Zdeněk Kabátek ²; Ústav zdravotnických informací a statistiky České republiky, Praha, ředitel doc. RNDr. Ladislav Dušek, Ph. D. ³; Institut biostatistiky a analýz MU, Brno, ředitel doc. RNDr. Ladislav Dušek, Ph. D. ⁴; Interní klinika 2. lékařské fakulty UK a FN Motol Praha, přednosta prof. MUDr. Milan Kvapil, CSc., MBA ⁵
Published in the journal: Vnitř Lék 2015; 61(Suppl 3): 39-43
Category: Original Contributions

Summary

Introduction:
Insulin pump treatment (IP) is one of the ways of intensive insulin therapy, designed preferentially for patients with type 1 diabetes. The price of the treatment is higher than that of the conventional basalbolus and insulin regimens using repeated insulin application with a dose selector.

Goal:
Quality assessment of IP therapy monitoring in patients with DM in a representative sample of the patient population with DM kept in the database of the General Health Insurance Company of the Czech Republic (VZP) which provided health care coverage for 63% of Czech population in 2014. Methodology: We identified all individuals in the VZP database who had a record of DM diagnosis (E10 – E16 based on ICD 10) or who had any antidiabetic therapy prescribed (ATC group A10) in the period of 2009–2013. Over the whole period of 2009–2014 there were overall n = 4 002 unique patients with DM identified in the VZP data, who were treated with IP within the assessment period. Incidence for the year 2014 (the newly treated with an insulin pump): all patients who had IP recorded in 2014 while in the preceding period of 2009–2013 they had no record of IP use. Prevalence for the year 2014 (all treated with an insulin pump): all the patients who for the period of 2010–2014 had at least once insulin pump use recorded and who did not die before 2014. Quality control parameters (HbA1c examination and consumption of glucose level test strips) for patients treated with IP were only assessed in detail for the year 2014, namely for all patients undergoing insulin pump treatment in 2014 throughout the year (i.e. from 1 January 2014 to 31 December 2014), i.e. in n = 3 189 patients in all.

Results:
In 2014 there were 247 incident patients and 3 794 prevalent patients. IP was newly introduced for almost 50% of the patients aged 20–39 years. In 2014 an average frequency of HbA_1c examination equaled 3.38 per patient and 98.5% patients were examined for HbA_1c at least once. An average consumption of glucose level testing strips per patient was 879 pieces.

Conclusion:
The pilot project of assessment of quality parameters for IP therapy monitoring shows that the patients treated with IP have glycated hemoglobin checked quite frequently (3.38 checkups per patient in 2014) and they measure their blood glucose 2–3 times a day on average.

Key words:
diabetes mellitus – monitoring of diabetes compensation – insulin pump – CSII

Zdroje

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