Efficacy of an education program for people with diabetes and insulinpumptreatment(INPUT): Results from a randomized controlled trial

Abstract

OBJECTIVE Continuous subcutaneous insulin infusion (CSII) is the most advanced form of insulin delivery, but it requires structured education to provide users with the necessary knowledge/skills and to support their motivation. Currently, no structured education program designed to provide this training has been evaluated. We developed a CSII-specific, structured education program (Insulin Pump Treatment [INPUT]) and evaluated its impact on glycemic control, behavior, and psychosocial status. RESEARCH DESIGN AND METHODS This was a multicenter, randomized, parallel trial with a 6-month follow-up. Eligible participants (age 16-75 years) currently were treated with insulin pump therapy. Participants were randomly assigned (1:1) to the INPUT program or to usual care using a computer-generated algorithm, with study center as the stratification factor. The primary outcome was HbA1c change from baseline to 6 months. Secondary outcomes were incidence of severe hypoglycemia and changes in behavioral and psychosocial measures. RESULTS Between 1 April 2016 and 26 April 2016, 268 people with diabetes and a mean duration of CSII therapy of 9.5 years were randomly assigned to the INPUT group (n = 135) or control group (n = 133). At 6 months, HbA1c improved in the INPUT group (8.33 6 0.8 vs. 8.04 6 0.9; P < 0.0001) but not in the control group (8.33 6 1.0 vs. 8.27 6 1.0; P = 0.11). The between-group difference in HbA1c reduction was significant, favoring INPUT (20.28% vs. 20.06%, D 20.22%, 95% CI 20.38 to 20.06; P = 0.0029). The incidence rate ratio of severe hypoglycemia was 3.55 times higher for participants in the control group than for those in the INPUT group (95% CI 1.50-8.43; P = 0.0041). CONCLUSIONS The INPUT education program led to a significant improvement in glycemic control and incidence of severe hypoglycemia in insulin pump users.