Effect of insulin pump use on diabetic ketoacidosis in type 1 diabetes mellitus: A matched cohort study

Background: Diabetic ketoacidosis (DKA) is a well-known complication of diabetes mellitus with a significantly high mortality if not immediately and properly treated. Therefore, strategies for prevention of DKA are ever so important when managing diabetes mellitus, especially in the non-compliant patient population. Previously studies have suggested insulin pump use to carry an increased risk of DKA compared to insulin injections, while European studies suggest the opposite. We aimed to perform a retrospective cohort study to determine the risk of DKA in insulin pump versus injection in the United States. Methods: We utilized the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS) 2017 database, which represents a 20% sample of all payer hospitalizations in the United States. These hospitalizations were systematically selected by the Agency for Healthcare Resources and Quality (AHRQ) and we included all type 1 diabetes mellitus patients over the age of 18 who were on insulin, either pump or injections, in our study. Results: We found a total of 58,260 admissions for patients with type 1 DM. Of these, 7850 had insulin pump, 30,672 used insulin injection, and 19,738 had no prior insulin use. We found that insulin pump use, compared to injections, failed to predict a lower incidence of DKA in hospitalized patients. Conclusion: Although several studies from European countries have found a reduction of DKA risk with insulin pump use, in this study we found no clear significant difference in a United States-based study. While this may be possible due to different legislating and regulation organizations, further studies are warranted to further evaluate the benefit of either insulin dispensing modality.